June 19, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

HCA Advocacy on All Cylinders in Legislative Finale



News

Volume 20, No. 24 June 19, 2015

HCA’s Infographic of the Week HCA is providing you with shareable social media content. Below is an infographic with tips from our Technology Symposium. Share the image on your Facebook feed by viewing the infographic on our page here: www.facebook.com/hcanys.

HCA bill to limit impact of CHHA EPS rebasing passes both houses HCA advocacy on home care priorities continues full steam as the State Legislature works to finalize its 2015 Session. In the most recent development as of ASAP press time, an HCA-written bill to limit the impact of CHHA Episodic Payment System rebasing unanimously passed the Assembly after passing the Senate earlier in the week.

HCA thanks our members who used HCA’s Legislative Action Center to urge support from your elected representatives on this bill in response to our action alerts this week. Once the bill is delivered to the Governor, it will require a sustained See FINALE p. 2

Inside ASAP HCA Advocacy on All Cylinders in Legislative Finale..........................1 Get Ready for ICD-10 Billing under Managed Care............................3 Member Hiring Announcement............................................................3 Leverage Your Staff Numbers for HCA’s Advocacy...............................4 ASAP Web Exclusives: NGS, Hospice CAHPS, MedPAC Report...............5 2016 Medicare HHPPS Proposal Coming Soon....................................5 QIVAPP Update.....................................................................................5 DSRIP Plans under Review, Lined up for August Posting......................6 DOH Issues New Medicaid Recoupment Rate Policy..........................6 EO 38 Disclosure Forms Due June 29...................................................7 Fair Hearing Change for MLTC Enrollees.............................................7 ICD-10 Readiness Tips, New Guidance...............................................8 NYC Home Health Jobs Increase 12%.................................................8 New Maximum Weekly Benefit Rate for Workers’ Compensation.......8 HCA Palliative Care Initiative Being Implemented Continuum-wide.......9 Get Updates on Transition to New Medicaid Billing System..............9 NYC Council Passes Bill Limiting Background Checks on Applicants...10 TBI & NHTD Transition to Managed Care Delayed............................11 ALP DAL Posted.................................................................................11

ASAP summer schedule schedule: During the summer, HCA will be publishing ASAP every other week. We will publish again next week, June 26, which will the last weekly edition of the summer. There will be no ASAP on July 3.

We will resume weekly publication in September.

Helping New Yorkers Feel Right At Home

Volume 20, No. 24 June 19, 2015

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



FINALE from p. 1 redirection of our advocacy to obtain his signature on this important bill.

Originally scheduled to conclude Wednesday, June 17, the Legislative calendar is continuing on tentatively until next Tuesday as major issues remain under negotiation, particularly New York City rent regulation, tax laws and education issues. This provides an additional window for continued HCA advocacy. We will be working at every opportunity to advocate for passage of home care supportive measures, and for reconsideration of items of concern and adversity for patients and agencies. We will also continue alerting the membership on items targeted for your grassroots outreach to officials, which we have facilitated for you through our Legislative Action Center and greatly appreciate your support so far.

As of ASAP publication, some of our priority areas include our recently passed bill to stop the adverse impact of the state’s rebasing of the CHHA episodic payment system at the 2015 state budgeted levels (the state Department of Health is planning cuts at two to three times that level), and additional bills to: provide for managed care-home care regulatory

relief, improve the telehealth coverage law enacted earlier in the session, modernize home care insurance coverage, and others.

Additionally, we are focusing on major concerns with bills authorizing “offsite services” for hospitals and clinics, community paramedicine programs and advanced home health aide services, and requiring licensure of Fiscal Intermediaries (on top of existing home care licensure) under the Consumer Directed Personal Assistance Program.

Please refer to the HCA website for background on these and other measures that we have reported to you. We recently published a web-exclusive article on pending legislation at http://hca-nys.org/policy-positions/majorlegislative-opportunities-and-challenges-in-session-winddown. Other bill summaries are in previous editions of ASAP. Following the session’s conclusion, HCA will prepare a comprehensive summary of the session’s outcome as it relates to home and community based care.

For further information, please contact a member of the HCA Policy staff.

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 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

2

Volume 20, No. 24 June 19, 2015

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



Get your Agency Ready for ICD-10 Billing under Managed Care ICD-10 is coming. And with managed care being a dominant payor in New York home care, you need to make sure that your agency is ready for service billing with your managed care partners by the October 1 implementation date.

HCA’s next installment of our Bootcamp series, on July 21, will focus on this hot topic, as you Prepare for the Transition to ICD-10 Diagnosis Codes in Managed Care. Don’t wait until the last minute. Register for this program today for a small member registration fee of $59. A registration form is at the back of this week’s ASAP.

HIRING Director of Programs & Services and Compliance Visiting Nurses Home Care is a Licensed Home Care Agency servicing 18 counties in the Capital Region and an affiliate of VNA Home Health, a Certified Home Health Agency certified in 11 counties.

We have a full time position open for a Director of Programs & Services and Compliance. This individual will be responsible for the delivery of quality care for all Agency Programs and Services as well as planning, implementing and monitoring the Agency Corporate Compliance Program. This position reports directly to the CEO and is based in the Menands office.

Requirements include a B.S.N. in Nursing or Registered Nurse with a Bachelor’s Degree in a related field.

Master’s Degree in Nursing or related field preferred. Minimum of three to five years Supervisory/ Management experience in a health care setting, preferably in Home Care or Community-based Services.

Must possess a current NYS Driver’s License and Current License & Registration to practice as a Registered Professional Nurse.

Please submit Resume to HR@vnhc.com

3

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

Volume 20, No. 24 June 19, 2015 

Leverage Your Staff Numbers to Participate in HCA’s Online Advocacy It’s called the domino effect, and we can all use it to great effect in our advocacy for home care services.

There are hundreds of you receiving HCA’s e-mail communications. And for every one you, there are hundreds more on your staff who HCA is not reaching through our e-mails.

Therefore, when we send you advocacy instructions using our Legislative Action Center, we ask that you invite your staff to also participate in this easy online tool to write their legislators on HCA’s priorities.

So far, about 320 of you sent more than 1,200 e-mail messages to the Legislature during this year’s session.

We know this because HCA’s Legislative Action Center includes an administrative dashboard (at right) for each legislative advocacy campaign showing us who is advocating – and on what issue – in real-time.

This year’s results were good, but we can do even better.

Please familiarize yourself with our Legislative Action Center and develop a process to invite your staff to use this tool, so that we can get many thousands more people advocating on critical issues.

This summer, in particular, we recommend setting up an e-mail list of your most engaged staff. When we send advocacy alerts, immediately forward those special instructions to your staff e-mail contacts so that hundreds more will write their legislators in a quick process that takes only a few minutes.

HCA wants to recognize Board Member Russell Lusak, Senior Vice President at Selfhelp Community Services, who took the time this week to forward our alerts to all of his directors and his organization’s Board, meaning that dozens more from his team acted on our advocacy campaigns. Many others on HCA’s Board did the same, and we ask that you likewise follow suit and engage your staff.

4

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

Volume 20, No. 24 June 19, 2015 

2016 Medicare HHPPS Proposal Coming Soon The Office of Management and Budget has signed-off on the publication of a proposed rule for the 2016 Medicare Home Health Prospective Payment System (HHPPS). However, the U.S. Centers for Medicare and Medicaid Services (CMS) has not yet made the proposed rule public. It will be posted for public review soon, likely within the next one to two weeks, at which point HCA will conduct an in-depth analysis.

QIVAPP Update State responds to joint association letter Late last week, after ASAP went to press, the state Department of Health (DOH) responded to a letter sent by HCA, LeadingAge NY and the New York State Association of Health Care Providers that expressed our concerns about the eligibility criteria under the Quality Incentive Vital Access Provider Pool (QIVAPP) program.

The letter took issue with DOH’s reinterpretation of the health benefit requirement that was outlined in the April 23, 2014 Dear Administrator Letter (DAL). The original requirement stated that an agency must provide comprehensive health insurance coverage to its employees, whereas the revised requirement stated that “a minimum of 30 percent of a provider’s total workforce must be enrolled in the health benefit” in order for the provider to qualify for QIVAPP funding (April 29, 2015 QIVAPP Webinar Frequently Asked Questions).

The joint Association letter is at http://hca-nys.org/wpcontent/uploads/2015/05/JointQIVAPletter52215.pdf.

DOH’s response is at http://hca-nys.org/wp-content/ uploads/2015/06/DOHQIVAPresponse06092015.pdf.

In discussions and other communications with DOH, HCA has consistently pointed out that this new policy penalizes home care providers who offer comprehensive health coverage but whose workers may choose not to

5

Go Online For ASAP Web Exclusives: NGS, Hospice CAHPS Updates, New Medicare Report In an effort to keep ASAP concise, we are posting some of our more technical content as special web exclusives. This information is important, so we ask that you take a look at our web offerings at http:// hca-nys.org/asap-newsletter/june19-2015-asap-newsletter.

This week’s online exclusives include our NGS updates, a report on some important Hospice CAHPS resources and requirements, and a story about a recent MedPAC Medicare report. You will not want to miss this important information that affects your billing, quality reporting requirements and other mandates.

To view this content, you need an HCA member account. Now is a great opportunity to get one. Simply write HCA’s Communications Director Roger Noyes (rnoyes@hcanys.org) with your name and e-mail address and he will set up an account for you. Not only will you be able to read our ASAP web exclusives, but your account will also give you access to HCA’s Data page, ASAP archives, alerts and much more.

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

Volume 20, No. 24 June 19, 2015 

participate in the provider’s health benefit because they access these benefits through other means or elect to receive a higher wage rather than obtain health coverage. We have argued that these agencies are incurring similar costs as those agencies whose workers opt for health insurance because these employers still have to provide cash or other benefits for aides who don’t choose the health benefit due to the wage parity law.

DOH responded as follows: The Department understands the concern raised that setting the 30% threshold could eliminate certain providers from a pool award if less than 30% of a provider’s employees are enrolled in the health benefit. However, as stated during the QIVAPP process and the DAL, the program intent is to reward plans that invest in their network providers. Part of the investment is for additional expenses incurred by providers from enrolling employers in a health benefit. The QIVAPP program awards the providers that incur the cost of employees in the health benefit. Additionally, the threshold was set at the lower level of 30% to account for employees that decline enrollment because they receive health benefits from other sources or for any other reason.

HCA will discuss with the other associations on next steps in response to the DOH letter and will keep members informed of our actions.

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

DSRIP Plans under Review, Lined Up for August Posting According to the state Department of Health (DOH), all 25 Performing Provider Systems (PPSs) under the Delivery System Reform Incentive Payment (DSRIP) program have submitted their Domain 1 Implementation Plans to the state. These plans are under review by DOH, partner state agencies and the DSRIP Independent Assessor. They will be made public following final approval in early August.

In addition, PPSs are preparing their first Quarterly Report for the period of April 1 to June 30, 2015. This report, due on July 31, 2015, will demonstrate progress on each of their chosen projects as measured by projectspecific milestones and metrics achieved during the reporting period. Guidance will be provided to the PPSs and shared with the public to provide further direction and information that will help PPSs prepare their Quarterly Reports.

DSRIP updates are on the MRT Innovation eXchange; sign up at https://www.ny-mix.org/signup.

DOH Issues New Medicaid Recoupment Percentages Policy DOH wants to lower the Medicaid dollars owed to the Department to minimize risk to the Global Cap The state Department of Health (DOH) released a letter this week to providers announcing a change in policy for standard Medicaid recoupment percentages in the case of new retrospective rate adjustments.

DOH states that it is seeking, by March 31, 2017, to eliminate outstanding retroactive rate and other Medicaid program liabilities owed to the Department because these liabilities pose a potential risk to the Medicaid Global Spending Cap. Continued on next page 6

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

Volume 20, No. 24 June 19, 2015 

 Continued from p. 6 The Department’s initiative will impact all such liabilities processed August 1, 2015 and after that cannot be paid in full within twelve months using the standard 15 percent recoupment percentage.

Based on the average of a provider’s weekly Medicaid cycle checks and the amount owed, DOH may increase a provider’s recoupment percentage above the standard 15 percent to ensure full payment within twelve months from the date of the first recoupment.

Providers that have any questions or concerns about this initiative may contact bimamail@health.ny.gov with the subject line “Accounts Receivable.”

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

EO 38 Disclosure Forms Due June 29 HCA reminds members that the disclosure forms under Executive Order (EO) 38 are due June 29 for most agencies. The disclosure form must be submitted online at http://executiveorder38.ny.gov/. To do so, agencies must first obtain a Grants Gateway account (www.grantsreform.ny.gov). Members are advised to leave enough time to complete the Grants Gateway process, which includes mailing an application, receiving a username and password and time to submit the disclosure form.

HCA also advises members to review the resources on the EO 38 website and consult with legal staff about the effect of EO 38 on their operations. The site includes a tutorial on completing the disclosure forms.

On June 4, HCA held a webinar on EO 38 and reviewed: the disclosure report; waiver process; “covered provider” status; limits on executive compensation and administrative costs; and pending court cases, including one with HCA’s involvement. Since EO 38 was enacted, HCA has submitted comments, met with Administration officials to voice our concerns, and held numerous educational programs.

Fair Hearing Change for MLTC Enrollees Starting July 1, individuals enrolled in MLTC plans will no longer have to exhaust the plan’s internal appeal process before requesting a fair hearing.

Importantly, aid to continue – under which the enrollee’s current services must continue – will only be available if an individual requests a fair hearing (not an internal appeal) and makes the hearing request before the effective date of the plan’s action, or within 10 days of the notice date, whichever is later. Enrollees are entitled to the right to aid-continuing without regard to expiration of the prior service authorization.

More information on this change and other Initial Adverse Determination notices are at http:// www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_model_notice_training_april-29.pdf and http://www.wnylc.com/health/entry/184/.

7

Volume 20, No. 24 June 19, 2015

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



ICD-10 Readiness Tips, New Guidance HCA bootcamp on July 21 will focus on ICD-10 Diagnosis Codes for Managed Care

NYC Home Health Jobs Increase 12%

The final guidance manual for the OASIS-C1/ICD-10 version of the OASIS data set, scheduled to be effective October 1, 2015, is now available. The only change between the draft and final version of the manual is the addition of the Office of Management and Budget (OMB) approval number.

The state Department of Labor has released data showing that home health care employment in New York City jumped 12 percent, to 121,400, in the past year.

All of the materials are at http://tinyurl.com/ldvynwp.

The National Association for Home Care and Hospice suggests that agencies take the following actions to prepare for ICD-10: •

First, assign a team responsible for ICD-10 preparations. This could be one or several individuals, depending on your agency size, who are aware of the gaps and can coordinate efforts to aid in improving preparedness.

•

Next, conduct a gap analysis. This allows the agency to understand its status in relation to meeting readiness goals.

•

Work with referral sources in obtaining as much information as possible because there will be a heavy reliance on documentation. Agency staff should be trained to ensure their documentation reflects accurate information related to diagnoses to allow for ICD10 specificity.

•

Develop a dual coding system to match how the current ICD-9 codes will translate into ICD-10.

•

Ensure your software vendors are ready – not only for the conversion but for testing with trading partners.

•

Engage with your payor sources and clearinghouses.

Testing with trading partners is imperative as part of your readiness process.

Continued on next page

8

The number of jobs at private hospitals in the city rose 2.7 percent year-to-year, to 170,000. Jobs at city nursing and residential care facilities fell 0.3 percent, to 75,400.

The report is here: https://labor.ny.gov/stats/nyc/ index.shtm.

New Maximum Weekly Benefit Rate for Workers’ Compensation The maximum weekly benefit rate for Worker’s Compensation will increase starting July 1, 2015 to $844.29. This rate will be in effect until June 30, 2016 for claims with dates of accidents or disablement during this period.

The amount is based on two-thirds of the state’s average weekly wage for 2014 ($1,266.44). More information is at http:// www.labor.ny.gov/stats/ avg_wkly_wage.shtm.

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

Volume 20, No. 24 June 19, 2015 

Continued from p. 8 A good federal resource is “ICD-10-CM/PCS Myths and Facts” at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10MythsandFacts.pdf.

HCA offers Bootcamp on ICD-10 Readiness under Managed Care HCA reminds you that we will be holding an education program on July 21 to help you prepare for the ICD-10 transition in your billing to managed care plans.

Please see the details of this program and register using the form at the back of this week’s ASAP.

HCA Palliative Care Initiative Being Implemented Continuum-wide Brief DOH-HCA home care survey coming to you next week The HCA Palliative Care and Hospice Forum developed and last year passed new palliative care (PC) access legislation. It aims to increase PC access through expanded opportunities for PC education, training and practice by nurses and social workers. It charges the State PC Council with examining curricula in schools of nursing and social work, as well as clinical practice settings for PC opportunities and support needs. A report will follow, with supportive recommendations to major state health and education officials.

The Council is asking HCA and associations across the continuum to help briefly survey providers to depict the current level of PC education, training and clinical participation, and potential requisite needs; professional nursing and social work schools will be similarly surveyed.

Providers please note: Next week, HCA will sending you this brief 5-to-10-minute survey. It is critical that all home care providers complete the survey, which will be used to inform the Council’s report and supportive recommendations.

This HCA initiative stands to be one of the most significant steps in potential palliative care support and development in years, and coincides perfectly with the state’s focus on delivery reform and value based payment.

HCA’s PC Forum will be convening next on July 14 in Albany, and will draw additional, critical input for this initiative. HCA providers engaged in PC or hospice are welcome to participate! Please contact Billi Hoen at bhoen@hcanys.org for details and participation.

Get Updates on Transition to State’s New Medicaid Billing System The state Department of Health (DOH) reports that it is working with Xerox State Healthcare, LLC on the design and development of the new Medicaid system, called New York Medicaid Management Information System (NYMMIS).

NYMMIS has developed an interim website dubbed as an ‘information billboard’. The interim website will have no impact on eMedNY nor will it be used for provider billing or other transactions. It includes a ListServ section (www.interimnymmis.com) where you can sign up to receive news and updates.

Continued on next page 9

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

Volume 20, No. 24 June 19, 2015 

Continued from p. 9 DOH recently announced that it will be transitioning to a new Medicaid system and fiscal agent, Xerox State Healthcare. The new system will utilize a web-based core platform, called Health Enterprise. According to DOH, it will provide “enhanced flexibility, interoperability, and data sharing capabilities, resulting in improved claims adjudication, fiscal management, and fraud and abuse deterrents.” Xerox is replacing Computer Sciences Corporation, the current Medicaid contractor.

NYC Council Passes Bill Prohibiting Employers from Inquiring about Applicants’ Criminal Background HCA is examining impact of bill on mandated criminal record checks for home care staff On June 10, the New York City Council passed the “Fair Chance Act.” The legislation was sent to Mayor de Blasio who is expected to sign it into law. It would become effective 120 days after the Mayor’s signing.

The bill language is at http://tinyurl.com/pdhlfap.

The Act prohibits private employers in New York City with four or more employees from inquiring into or considering an applicant’s criminal background history prior to extending a conditional offer of employment.

Under the Act, employers may only inquire into an applicant’s criminal history after extending a conditional offer of employment. The Act defines “inquiry” as “any question communicated to an applicant in writing or otherwise, or any searches of publicly available records or consumer reports that are conducted for the purpose of obtaining an applicant’s criminal background information.”

The Act also prohibits private employers from distributing any advertisement that expresses any limitation or specification in employment based on an individual’s arrest or criminal conviction.

Under the bill, employers who inquire into an applicant’s criminal history after making a conditional offer of employment must comply with certain requirements before taking any adverse employment action based on such inquiry. This includes providing the applicant with written copy of the inquiry and an analysis required by Article 23(a) of the New York Corrections Law, and allowing the applicant three business days to respond while the position remains open to the applicant.

The Act does not apply to any actions taken by employers pursuant to any federal, state or local law that requires criminal background checks for employment purposes or bars employment based on criminal history.

HCA is researching how this law affects New York home care providers, as they already are required to conduct criminal history record checks on certain prospective employees that will provide direct patient care. We have already sought some clarification from the state Department of Health and our counsel.

This article was based on information provided by FordHarrison.

10

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

Volume 20, No. 24 June 19, 2015 

TBI & NHTD Transition to Managed Care Delayed The state Department of Health (DOH) is delaying the transition of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs to Medicaid managed care (mainstream and managed long term care).

DOH is extending the start date from January 1, 2016 (for NHTD services) and April 1, 2016 (for TBI services) to January 1, 2017 for both programs.

DOH’s notification letter stated that it will convene a stakeholder work group which will discuss and develop recommendations regarding various issues in order to ensure development of a transition plan.

The work group is expected to be convened shortly and make recommendations by August 1, 2016.

The Department has also agreed to maintain the current fee-for-service NHTD and TBI reimbursement rates for two years after transition.

Legislation had been proposed and was under serious consideration that would delay the transition of the NHTD and TBI populations into Medicaid managed care until April 1, 2017 and would establish a work group to develop recommendations on the transition.

ALP DAL Posted The state Department of Health (DOH) has posted a Dear Administrator Letter (DAL) that clarifies requirements for the Assisted Living Program (ALP). The DAL describes participant eligibility criteria; who cannot receive ALP services; the factors (doctor’s order, assessment, evaluation and interview) that are used to determine program eligibility; and a description of the assessment process and outcomes data.

The DAL is at http://hca-nys.org/wp-content/uploads/2015/06/DALALP061815.pdf. ALP questions can be directed to acfinfo@health.ny.gov

11

Tuesday, July 21 9:30am – 12:00Noon

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

Fee: $59 for HCA members; $119 for Non-members

HCA is offering a series of Home Care Survival Bootcamps throughout the coming months to provide tools, tips and strategies that will help home health providers thrive in an increasingly challenging marketplace and regulatory environment.

This series focuses on specific issue areas, offering practical ideas and methods for skill building.

Part V in this series, on July 21, offers vital information on how to prepare for the transition on October 1, 2015 from ICD-9 to ICD-10 diagnosis codes. This program will focus on what actions various managed care plans are taking to educate their network providers so that claims will continue to be paid after September 30th.

Thanks to our Breakfast Sponsor:

Registration Deadline is July 14, 2015.

REGISTRATION – (Deadline July 14)

REGISTRATION FEE

Name: _________________________________________________

HCA Members

Title:__________________________________________________

PAYMENT

Agency:________________________________________________

____MasterCard

Address:_______________________________________________

*Make checks payable and mailed to:

City/State/Zip:___________________________________________ Phone:______________________________ Ext._______________ Email: _________________________________________________ Cancellations received by July 14 are refundable less a 25% administrative fee.

Cancellations must be received in writing via e-mail to info@hcanys.org.

No refunds after that time or for no shows. Substitutions are permitted.

FAX TO: (518) 426-8788

$59 ________

____VISA

Non-Members

$119 ________

____ American Express

________ Check*

HCA Education and Research 388 Broadway, 4th Floor, Albany, NY 12207

Credit Card #: _______________________ Exp. Date:_______ Security Code: ________ _________________________________________________________________________ Name and/or Company Name on Card _________________________________________________________________________ Billing Address of card (including City, State and Zip Code) _________________________________________________________________________ Authorized Signature