September 4, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 30 September 4, 2015

Urgent: Your Advocacy Needed on Medicaid EPS Rebasing Today! As previously reported to the membership, the Legislature unanimously passed an HCA-developed bill (S.5878/ A.8171) to limit the level of CHHA Episodic Payment System (EPS) rebasing cuts, which have an impact on all home care agencies serving the Medicaid population, from CHHAs to their subcontracting LHCSAs. This bill, crafted in cooperation with HCA’s association partners, awaits delivery to the Governor. However, in an urgent development last month, the state Department of Health has separately advanced a rebasing plan that would double or triple the size of rebasing cuts established in the state fiscal plan, risking provider stability and the ability of providers to participate in the administration’s own health care reform initiatives. See EPS p. 2

HCA Vets“Face-to-Face” Proposal with CMS Fiscal Intermediary

HCA Submits Comments on HPPS Rule for Medicare Home Health

This week, HCA and a workgroup of members met with the U.S. Centers for Medicare and Medicaid Services (CMS) Medicare Administrative Contractor National Government Services (NGS) to vet the workgroup’s latest draft of a face-to-face addendum for physician records.

HCA today submitted extensive comments on the U.S. Centers for Medicare and Medicaid Services proposed rule for the 2016 Home Health Prospective Payment System (HHPPS).

See F2F p. 2

Inside ASAP Urgent: Advocacy Needed on Medicaid EPS Rebasing Today!..........1 HCA Submits Comments on HPPS Rule...............................................1 HCA Vets Face-to-Face Proposal with CMS Intermediary....................1 Member Hiring Announcement.............................................................3 Companionship Exemption Rule Update............................................4 Funding Available Under ‘Access to Home’ Program............................5 Revision to HHA Change of Address Timeframe.................................5 Hear NAHC’s Bill Dombi at HCA Conference.......................................6 HCA Education Update......................................................................7 Diving Deeper into VBP Shared “Risk/Savings”....................................8 HCA Continues Home Care Priority Discussions with Lawmakers......9 Register Today for Oct. 13 Bootcamp Session......................................9 HCA Committee to Conduct Sepsis Beta Test 2.................................10 DOH, Home Care Explore New Emergency Preparedness Areas......10 CMS Reports Results of ICD-10 Testing..............................................11 New DSRIP FAQs and OMIG Guidance...............................................12 Managed Care Roundtable & Transportation Carve-Out Update....13 NHTD/TBI Stakeholder Group Meets.................................................14 DOH Releases May 2015 Global Cap Report.....................................14 CAHPS Hospice Survey Training Registration Now Open.................15 Medicare Advantage Value-Based Model Announced.......................16 Changes in Billing Home Care Services in OPWDD Residences.........16 Care At Home and Medical Indemnity Fund.....................................16 NGS Updates......................................................................................17 Publications...................................................................................17

The comments address such areas as the continued methodology flaws in CMS’s rebasing of Medicare home health rates, including the incorporation of a “case-mix-creep” adjustment that appears to adjust See COMMENTS p. 3 HCA’s offices will be closed on Monday, September 7 for the Labor Day holiday and will reopen on Sept. 8.

Helping New Yorkers Feel Right At Home

Volume 20, No. 30 September 4, 2015

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

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EPS from p. 1

F2F from p. 1

The Governor’s signing of S.5878/A.8171 would establish more reasonable limits on rebasing for CHHAs and their contracting LHCSAs. We need you and your staff to urge the Governor’s positive action on this bill as soon as it arrives at his desk.

The proposed one-page, streamlined addendum records the criteria CMS requires to certify the face-to-face encounter as well as the patient’s eligibility for Medicare covered home health services. NGS stressed that other documentation in the physician’s record must still be consistent with and validate the criteria reflected on the form.

Your action needed now!

This was a follow-up to an initial vetting with NGS and it incorporates the results of that discussion. HCA plans to similarly incorporate this week’s NGS input into a revised draft, and then move to convene a combined HCA, NGS, hospital and physician association meeting to vet and discuss implementation with these partners.

HCA has posted a new campaign to our Legislative Action Center at http://p2a.co/PqrSggn. As soon as you are finished reading this article, we ask that you click this link to immediately write Governor Cuomo urging his approval of S.5878/A.8171 on behalf of New York’s home care system. All you need to do is click the campaign link (again at http://p2a.co/PqrSggn), fill in your contact information and send an e-mail directly to Governor Cuomo. A pre-written message will be sent to his office with a push of the button, though you are welcome to edit the message before sending. This process should take less than a minute of your time.

NGS offered to conduct sessions for home care providers, hospitals and physicians to help educate and facilitate compliance. HCA will keep members informed of the developments in this process. HCA extends thanks to the workgroup members for their efforts on this important initiative.

Please forward this action item to all of your staff and urge them to take action today.

For further information, please contact Al Cardillo at acardillo@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 Alexandria Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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COMMENTS from p. 1 the rebasing cuts to a level beyond that authorized by Congress. We also seek CMS action to address the lack of a comprehensive impact analysis for rebasing and the failure of rebasing to incorporate all usual and necessary indirect and direct costs in CMS’s analysis. HCA’s comments also address CMS’s silence, in the proposed 2016 rule, on the question of Medicare face-toface documentation issues which continue to plague providers with administrative costs and access-to-care burdens. (See related p. 1 story on HCA’s work in this area.) We also address concerns about CMS’s planned value-based purchasing pilot. Though the pilot would not include New York State (nine other states are included), we argue that the pilot, overall, requires important methodological and risk-load changes, and we note that New York is simultaneously advancing a value-based payment program that warrants compatibility with any federal initiative affecting New York providers. HCA’s comments additionally address: proposed changes to the OASIS submission process; proposed wage index changes; the outlier policy; funding for Health Information Technology/Exchange and other aspects of the rule. For each area of concern, HCA outlines specific recommendations. Members can read our comments at http://hca-nys.org/wp-content/uploads/2015/09/ HCANYSCY2016HHPPSProposedRuleComments.pdf. A final rule is anticipated by November, with the 2016 HHPPS going into effect on January 1. To learn more about the impact of the rule, members should be sure to attend HCA’s Senior and Financial Manager’s Retreat on September 17 and 18 at the Mohonk Mountain House resort in New Paltz. Bill Dombi, of the National Association for Home Care and Hospice, will devote much of his presentation on this topic, along with other federal policy updates. (See related p. 6 story.) For more information, please contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

CHHA Supervisors

HIRING

Home care continues to grow as an essential part of the overall continuum of care, and North Shore-LIJ Home Care Network is leading the way. We’re expanding our service area and providing exciting new opportunities for Nursing Professionals ready to take their career in a new direction! We are currently seeking CHHA Supervisors in New Hyde Park and Westbury, NY. Responsibilities include coordinating community nursing services; supervising, instructing, and guiding nursing personnel toward high quality care; interpreting and implementing the agency’s policies and objectives; coordinating and evaluating nursing care and providing information and guidance to other disciplines. To qualify, you must have a Bachelor’s Degree in Nursing, a current license to practice as a Registered Professional Nurse in New York State, a current Driver’s License and minimum of 2 years’ experience as a Registered Nurse in a community health setting. Must have own transportation available to provide on-site supervision. Master’s Degree is preferred. CHHA setting and CHHA supervisory experience are also preferred. Apply online at NSLIJCareers.com and search by keyword 000BVO or 000CZZ.

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Volume 20, No. 30 September 4, 2015 

Update on Companionship Exemption Rule Court Appeal Process In response to the August 21 decision by the U.S. Court of Appeals on the Fair Labor Standards Act (FLSA) final rule (upholding the U.S. Department of Labor’s “companionship exemption” changes for home care), plaintiffs at the National Association for Home Care and Hospice (NAHC) and others intend to appeal to the U.S. Supreme Court. As a first step in that effort, NAHC and the other association plaintiffs have filed a Motion for Stay with the U.S. Court of Appeals. A stay generally would prevent the final rule from taking effect until the U.S. Supreme Court decides whether it will hear the appeal. At the same time, the U.S. Department of Justice, representing the U.S. Department of Labor (U.S. DOL), filed a Motion for Expedited Issuance of the Mandate. NAHC and its co-plaintiffs see the Motion for Stay as a key step in the appeal to the Supreme Court. According to NAHC, if a stay is not granted, the rules will go into effect on or about October 13 (depending on the speed of the lower court’s action) even if there is a request for an appeal pending before the Supreme Court. In its Motion, NAHC and the co-plaintiffs argue that a stay is necessary to protect the interests of consumers, workers, home care businesses, and state Medicaid programs while the Supreme Court considers whether to take on the appeal. If the Court of Appeals ruling goes into effect, plaintiffs argue that consumers will face problems with access-to-care, a loss of continuity-of-care as the workforce shifts to part-time employees, and a risk that quality of care deteriorates when multiple caregivers replace a single one with a patient/client. The U.S. DOL’s competing Motion seeks to have the Court of Appeals ruling take effect earlier than the October 13 date, but does not specifically suggest an earlier date. The Court of Appeals has ordered that each party submit a response to the competing motions by September 14. It is expected that the Court will issue its rulings on the motions quickly thereafter. In the meantime, NAHC and its co-plaintiffs are preparing to file a Petition for Writ of Certiorari requesting that the U.S. Supreme Court hear the appeal. This week, U.S. DOL indicated that it intends to enforce the FLSA final rule that eliminates the “companionship exemption” for home care agencies 30 days after the recent U.S. Court of Appeals decision becomes effective. This would not be the case if the Court of Appeals grants a stay, in which case the final rule will not be in effect. U.S. DOL’s notice is at http://www.dol.gov/whd/homecare/litigation.htm. U.S. DOL had earlier indicated that it would “selectively enforce” the FLSA rule from July 1 to December 31, 2015. “Selective enforcement” means that U.S. DOL plans to “exercise prosecutorial discretion in determining whether to bring enforcement actions, with particular consideration given to the extent to which states and other entities have made good faith efforts to bring their home care programs into compliance with the FLSA since promulgation of the Final Rule.” This selective enforcement was posted at http://www.dol.gov/whd/homecare/non-enforcement_policy.htm. Continued on next page

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Continued from p. 4

Funding Available Under ‘ Access to Home’ Program

HCA continues to advise members that despite this policy, home care providers could still be subject to private lawsuits during this period and, thus, U.S. DOL’s policy does not afford them the necessary protections from employees and their attorneys enforcing the rules in a private action.

Funding is available under the Access to Home Program, which provides financial assistance to property owners to make dwelling units accessible for low-and moderate income persons with disabilities.

HCA will keep members informed on any new legal developments that impact the implementation date of the final rule.

Grants are to be made to municipalities and eligible not-for-profit entities that have substantial experience in adapting or retrofitting homes for persons with disabilities.

Meanwhile, members should prepare to comply with the new rule. For New York State, which has its own labor laws that intersect with federal regulations, the effect of the U.S. DOL policy change would be that home care providers must pay overtime at time-and-a-half of the home health aide’s regular wage (as opposed to time-and-a-half of the minimum wage). It would also require new recordkeeping administrative functions for live-in cases.

Applications are due September 21. More information, including the application, is at: http://www.nyshcr.org/AboutUs/Offices/ CommunityRenewal/ HousingResourcesFundingOpportunities.htm

In response to the Court of Appeals decision, the Secretary of Labor sent a letter to state governors on September 2 (http://www.dol.gov/whd/ homecare/letter-to-governors-sept.pdf ) that encourages states to prepare for compliance now. The Secretary states in the letter:

Revision to HHA Change of Address Timeframe The U.S. Centers for Medicare and Medicaid Services (CMS) has revised the timeframe in the State Operations Manual (SOM) from 30 to 90 days during which home health agencies (HHAs) must notify their Medicare Administrator Contractor (MAC) of a change of address.

As you know, this is a crucial issue affecting many of your state’s citizens, including lowwage workers, seniors, and individuals with disabilities, that could require an adjustment to your state’s budget or programs as well as careful and timely attention to the legal rights afforded to individuals with disabilities.

The information is in a guidance to state survey agency directors at https://www.cms.gov/ Medicare/Provider-Enrollment-andCertification/SurveyCertificationGenInfo/ Downloads/Survey-and-Cert-Letter-15-51.pdf.

HCA will be raising with state administrative officials the cost implications of the final rule on managed care rates and payments to home care providers under managed care and fee-for-service Medicaid and advocate that such expenses be built into the payment system.

The change is being made to the SOM so that it is consistent with the Provider Enrollment regulations at 42 CFR 424.516(e)(2).

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 5

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Hear NAHC’s Bill Dombi at HCA Conference in September: Registration Deadline Extended to Sept. 11 Bill Dombi, of the National Association for Home Care and Hospice (NAHC), is speaking at HCA’s Senior & Financial Manager’s Retreat on September 17 to 18. In anticipation, he recently shared these thoughts with HCA members: I am honored to have the opportunity to be part of the upcoming HCA Senior & Financial Manager’s Retreat. It is an incredible program with state-of-the art information. These are exciting times for home care. In many ways, health care is in the midst of a revolution with home care taking an increasing role in the future delivery of health care services. Keeping people in their own homes and out of costly hospitalizations and institutional care is driving this new era in care. I am truly excited for home care with the great opportunities it has today. I will cover all of these developments from rate rebasing to hospice payment reforms to the new innovations with value-based-purchasing and post-acute care bundling.

Here are some other reasons why you’ll want to hear from Bill Dombi: •

He is NAHC’s legal representative in a court case now being prepared for appeal to the U.S. Supreme Court on changes to the Fair Labor Standards Act (“companionship exemption”) for home care services. (See related p. 4 story.) You’ll want to know the evolution of this case, what to expect next, and potential consequences for wages and recordkeeping.

•

Bill Dombi knows the face-to-face requirement like nobody else. In fact, he is also NAHC’s legal representative in a separate lawsuit seeking to reconcile major problems with the requirement. These problems include more recent federal ‘guidance’ that has only thrown the F2F process into further confusion for home care providers and physicians. If there is anyone who can cut through the haze on this issue, it is Bill Dombi.

•

He is a leading authority on Medicare rebasing, and a cogent voice on this complicated structure of payment changes directly affecting your bottom line. His insights will help you forecast for 2016 and understand developments on the national front to effect change and prepare for the future.

•

In addition to knowing the intricacies of these policy issues, he is unmatched in his ability to convey the broader vision of state policy changes, new models, and NAHC’s own advocacy in these areas, as his quote above makes quite clear.

•

And he is only one of several speakers at HCA’s conference, which will delve into every corner of home care finance that you need to know about as a CFO, finance manager or home care executive, from CHHA rebasing, to physician orders, to value-based payments, to MLTC and home care financing policies, to TPL audits, to wage parity and everything in between.

Sound good to you? The registration deadline is coming up fast, on September 11, so please register today using the brochure at the back of this week’s ASAP, or register online at http://tinyurl.com/pp3aac9!

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SEPTEMBER EDUCATION UPDATE August 26, Sept. 9, Sept. 23: PHARMACOLOGY FOR THERAPISTS & OTHER INTERESTED CLINICIANS (Webinar Series). This series will review the profile of the typical rehabilitation patient, the common adverse drug reactions observed, the impact of side effects of treatment outcomes, and the problems of polypharmacy. Audio recording available click here to view brochure

Sept. 9: FUTURE OF HOME HEALTH NORTHEAST REGIONAL SYMPOSIUM – “PREPARING FOR THE FUTURE OF HOME AND COMMUNITY-BASED CARE” (NYC). This program is sponsored by the Alliance for Home Health Quality and Innovation along with nine state home care associations, including HCA. The symposium will feature panelists and speakers on alternative models of care delivery, achieving the ‘Triple Aim’, shifting care into the home and community, and research and policy priorities. Click here to register online

Sponsored in part by:

Sept. 17-18: HCA’S SENIOR & FINANCIAL MANAGER’S RETREAT (New Paltz). HCA will help you check items off your home care finance ‘worry list’ by providing the information you need from health care’s top officials and industry experts. Agenda Update: For this conference, we’ve added a new topic that is replacing a previous session on value-based payment. The new session will provide “Perspectives and Insights from the Health Plans,” featuring Kathy Preston of the Health Plan Association. Learn more by clicking the full brochure here. Also, the online registration deadline has been extended until Sept. 11. Sept. 30: ICD-10-CM & OASIS CODING BACK TO BASICS & BEYOND (Nanuet) Oct. 1: OPTIONAL CODING EXAM (Nanuet) Ensure success with your CHHA’s ICD-10-CM transition. On September 30, presenter Patricia Tulloch will help sharpen your clinician and coder skill sets to enhance documentation that supports ICD-10-CM diagnoses precision and verifies the consistency of the OASIS assessment. The 2015 Home Care Coding Specialist Exam (HCS-D) will be offered at this same location on October 1. Click to view brochure

Oct. 8: HCA’S CORPORATE COMPLIANCE SYMPOSIUM (Albany). New York is making epic changes to its health care system. These changes have spawned regulatory compliance and legal questions that are equally big. HCA will help you manage some of these huge questions, and others, so you can develop the right protocols and practices at your agency. Click to view brochure Oct. 13: HOME CARE SURVIVAL BOOTCAMP – STAYING AHEAD OF CHANGES IN LABOR LAW (NYC). This session of our popular Bootcamp Series tackles the new changes in overtime for executive, administrative and professional staff and provides an update on the paid sick leave law for NYC. Registration form

Visit our Events and Education page for additional details and registration information: http://hca-nys.org/eventseducation/upcoming-events

Oct. 20: SUPERVISION PLUS (Albany). Presented by Dr. Robert Fazzi, Supervision Plus is a full-day skill development, how-to-do-it training designed specifically for supervisors, managers and directors in home care and hospice agencies. Supervisors and managers not only learn the most effective strategies for supervising and motivating staff , they also learn the newest supervisory approaches for increasing the morale, team commitment and retention of valuable employees. Click to view brochure Several Dates through June 2016: TELECONFERENCES FOR HOME HEALTH AND HOSPICE AIDES (Teleconference). An investment in staff education is an investment in quality customer service and quality care. Topics covered include the Aide’s Role in: Disaster Preparedness; Legal Aspects of Documentation; Transferring Clients Safely; and Communication. Click to view brochure

SAVE THE DATE: Nov. 17-18, 2015- HCA’s Quality Symposium (Troy)

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Diving Deeper into VBP Shared “Risk/Savings” Subcommittees convened by the state Department of Health (DOH) continue meeting to tackle design aspects of the state’s planned Value Based Payment (VBP) system. Focus areas include technical design, risk sharing, social determinants of health, community based services organizations and preliminary clinical areas for targeting of VBP. HCA and HCA providers are participants in all of these subcommittees, and HCA also serves on the state’s overall core steering committee for VBP. Parameters for risk sharing and shared savings were part of a major discussion held late last week. The subcommittee examined questions of risk sharing/shared savings levels that may be permissible for providers, how these arrangements should be prior approved by DOH, and to what extent they should meet DOH fiscal standards or the still-greater financial security requirements of the State Department of Financial Services (formerly the Department of Insurance). These parameters, which will eventually be shaped into committee recommendations, will significantly determine the possibilities and playing field for shared risk/savings levels, negotiation and participation. Financial security levels alone will have a major impact on which entities will be able to negotiate and participate in the higher (and highest) levels of both risk and savings, and how broad a spectrum of services (e.g., partial care, total care, condition-specific, total population) would be encompassed in the VBP arrangement. The subcommittee also discussed which entity-types should be authorized to negotiate and contract VBP terms. The subcommittee coalesced around permissibility of individual providers, Independent Practice Associations (IPAs) and accountable care organizations (ACOs) as potential contract/negotiating entities and, at least at this time, heavily leaned toward not allowing such standing for Delivery System Reform Incentive Payment (DSRIP) program Performing Provider Systems (in lieu of IPA/ACO formation). VBP Highlighted at Finance Conference Two Weeks From Today If any of these issues related to provider risk-sharing, VBP partnerships and payment arrangements interest your agency – as they should – you will not want to miss HCA’s Senior & Financial Manager’s Retreat on September 17 and 18, just two weeks away, where we’ll have a special session on VBP partnership opportunities, among other topics. Please see the registration form at the back of this week’s ASAP. The deadline to register has been extended to September 11. Resources The VBP team also shared the next iteration of DOH’s draft proposal to CMS to allow the state and the state’s Medicare providers to opt to align Medicare VBP payment with the state’s VBP methodology. DOH posted the initial draft for public comment and is seeking any further comments from the VBP committee members. HCA members can view the slides from the risk sharing discussion at http://hca-nys.org/wp-content/uploads/ 2015/09/VBPRegImpactmeeting082415.pdf. The latest draft proposal on potential Medicare alignment is at http://hca-nys.org/wp-content/uploads/2015/09/MedicareMedicaidVBPalignmentdraftv3.pdf. For further information, please contact Al Cardillo at acardillo@hcanys.org.

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HCA Continues Home Care Priority Discussions with Lawmakers HCA continued meeting with lawmakers this week to advance the home care community’s needs and priority concerns in the post-session/pre-planning period for upcoming state Legislative and budget activity. In these discussions, HCA sought to further map out plans and support for our legislative and policy proposals relating to home care/managed care payment adequacy, quality innovation, clinical and health information technology, rebasing of the state’s Medicaid episodic payment system (EPS), regulatory/mandate relief for home care-managed care, workforce needs, and challenges/needs for participation in the state’s new and emerging models of care. As part of our EPS advocacy specifically, HCA this week sent members an alert urging you to write Governor Cuomo in support of a bill that would limit the size of rebasing cuts. If you have not sent this advocacy message, please do so immediately at http://p2a.co/PqrSggn. (See also the related p. 1 story for details.) HCA also highlighted some of the current public health initiatives being undertaken by our association and agencies, and their value to the patients and the overall system. HCA also underscored the need to specifically address unique system and resource needs in small communities and rural areas. We will keep the membership apprised of developments using our upcoming HCA forums and provider venues for priority home care items and initiatives. HCA’s upcoming Senior and Financial Managers Retreat, Corporate Compliance Symposium, Quality Symposium and regional provider meetings will provide critical opportunities to further identify and hone priority program needs. Some of these sessions are open for registration while information on others is coming soon. Please see our education update article on p. 7 for details. For further information, please contact Al Cardillo at acardillo@hcanys.org.

Register Today for Oct. 13 Bootcamp: Staying Ahead of Changes in Labor Law On October 13 in New York City, HCA is holding the next installment of our popular home care Bootcamp series, this time with a focus on labor law issues. This half-day program will focus on two important facets of home care labor law: Changes in Overtime for Executive, Administrative and Professional Staff and an Update on the Paid Sick Leave Law for NYC HCA’s Bootcamp series provides a set of succinct issue-specific programs with actionable information meeting the technical needs of home care providers. Learn more and register for the October 13 program by downloading the PDF brochure at http:// tinyurl.com/ode5m6t.

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HCA Committee to Conduct Sepsis Beta Test 2 Initiative aimed at addressing number 1 cause of 30-day hospital readmits HCA is preparing to launch a second-round beta test of a sepsis screening tool and protocol for home care developed by a sepsis workgroup of the HCA Quality Committee. The initial beta, conducted in late-July/early-August, affirmed the ease of use and utility of the tool, and led to recommendations for a broader, follow-up beta. The HCA Quality Committee/Sepsis Workgroup has been exploring whether, based on the outcome of these beta tests and further vetting, incorporation of the tool within home care should ultimately evolve into a full program initiative, with supported education for providers and staff. With the catastrophic health effects and costs so frequently accompanying sepsis, early recognition and intervention through home care could provide a significant contribution to the overall health care system’s response to sepsis. Often, patients access care through hospital emergency rooms with unrecognized symptoms, and by the time of eventual diagnosis and intervention, are already at risk of morbidity and death. The most recent available data (2013) showed sepsis to be the number one cause of 30-day Medicare hospital readmissions in New York State. Moreover, a national study showed sepsis to be the second leading condition for hospital discharge to home care in New York. In this regard alone, presentation of effective home care and partner intervention in sepsis early recognition should be an area of considerable interest within your Delivery System Reform Incentive Payment (DSRIP) program and value based payment discussions. While the beta test is being conducted through the Sepsis Workgroup and Quality Committee, other interested providers should contact Al Cardillo at HCA (acardillo@hcanys.org) or Amy Bowerman, HCA Sepsis Workgroup leader and Quality Director at Mohawk Valley Health System (abowerma@mvhealthsystem.org). The beta test is scheduled for September 14 through October 9.

September is Sepsis Awareness Month Meanwhile, September is Sepsis Awareness Month! The National Sepsis Alliance webpage (http:/ /www.sepsis.org/sepsisawarenessmonth/) gives important background, resources and ideas for efforts you might want to undertake in your agencies, with your patients and communities.

DOH, Home Care Jointly Exploring New Emergency Preparedness Areas HCA and a working group of home care agency leaders have been invited to work with the state Department of Health (DOH) on several new, key programs in emergency preparedness. The group met this Thursday in New Rochelle, NY, to examine the DOH Transportation Assistance Levels (TALs) and Evacuation of Facilities in Disasters System (eFINDS) programs, specifically how (and whether) these programs can be implemented in home care. TALs is a system that matches patients and emergency transport needs for planned evacuation in preparation for an emergency. eFINDS is an information and identification system to track, 10

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locate and access critical data on patients in emergencies. Home care leaders and DOH discussed the practical applicability, utility and compatibility of these programs with home care. The group offered a series of preliminary recommendations for achieving TALs/eFINDS goals in home care in a streamlined and more seamless manner. The group also discussed unique challenges to home care and home care patients in emergency preparedness, including, for example access to patients in home and community based settings; the increasing acuity and complexity of home care patients; the lack of technology financing in home care; need for “essential personnel” status for home care and hospice personnel (as reflected in an HCA bill awaiting delivery to the Governor); and need for clarity on managed care versus provider roles in emergency response. Further discussions are planned in determining the state’s course on these initiatives. HCA will provide updates as this work progresses. For further information, please contact Al Cardillo at acardillo@hcanys.org.

CMS Reports Results of Final Medicare FFS ICD-10 Testing Week in July Acknowledgement testing still active, as well as Medicaid testing through eMedNY The U.S. Centers for Medicare and Medicaid Services (CMS) reports that during the week of July 20 to 24, Medicare fee-for-service (FFS) health care providers and partners participated in a third successful ICD-10 endto-end testing week. While end-to-end testing is completed, providers and partners can still participate in acknowledgement testing. Additional information on acknowledgement testing is at http://tinyurl.com/nu2s3xr. Further information to prepare for ICD-10 in October Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015, or to accept claims that contain both ICD-9 and ICD-10 codes. CMS has created a number of ICD-10 tools and resources for providers such as the “Road to 10,” which can be accessed at http://www.roadto10.org/. More resources and information are at https://www.cms.gov/Medicare/ Coding/ICD10/Medicare-Fee-For-Service-Provider-Resources.html. Medicaid ICD-10 Transition Tools While Medicare has reported on the final results of ICD-10 end-to-end testing, eMedNY continues to add resources to help providers with the transition from ICD-9 to ICD-10 diagnosis codes, and providers can still engage in Medicaid testing of ICD-10 through eMedNY. New resources (at www.eMedNY.org/icd) include: • • •

The complete list of 2016 ICD-10-CM valid codes and code titles; Resources for unspecified codes and how they should be used; and Ways to keep up to date with information on ICD-10 via the web, e-mail and twitter.

Electronic claim submitters can still test using eMedNY’s Provider Test Environment, after researching the applicable ICD-10 codes and making sure that your software submits the appropriate Code List Qualifier Code. eMedNY 11

Volume 20, No. 30 September 4, 2015

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

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does not provide a method to test claims submitted on paper. ePACES features an ICD Version radio button which paper submitters will be required to select after October 1. This field currently defaults to ICD-9 as shown in the ePACES Claim Quick Reference Guides at https://www.emedny.org/selfhelp/ePACES/ ClaimQuickRefDocs.aspx. Capitation claims under managed care are submitted to eMedNY in the X12 837 Institutional format. The 837I format requires submission of a diagnosis code on every capitation claim. Therefore, for submission of the October capitation claims, managed care plans are reminded that an ICD-10 diagnosis code must be included in that submission or the claims will be rejected by eMedNY. For plans submitting an ICD-9 primary diagnosis code of 7999 (“Other Unspecified Diagnosis”), the state recommending using ICD-10 code R69-”Illness, unspecified” to replace 7999. Other Resources Materials from an August 25 webinar entitled, “Getting Ready for ICD-10,” by National Government Services (NGS), are at http://tinyurl.com/njmcpzq. “Hospice Frequently Asked Questions About ICD-10,” by NGS, are at http://tinyurl.com/qecv2n5. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

New DSRIP FAQs and OMIG Guidance The Delivery System Reform Incentive Payment Program (DSRIP) Frequently Asked Questions document has been updated and is available at http://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_faq.pdf. Some new sections were added including: new governance structures; additional DSRIP funds; data sharing and security; opt-out process; and claims data. One new question on network providers clarifies that while the Performing Provider System (PPS) networks are closed, PPS networks will be open for new partners in the near future. A revised question that should be reviewed is the role of managed care organizations. The FAQs may be revised quarterly (or as needed). Any questions may be directed to dsrip@health.ny.gov. OMIG Revises DSRIP Guidance The state Office of the Medicaid Inspector General (OMIG) has posted DSRIP Compliance Guidance 2015-01 Revised: Special Considerations for Performing Provider System (PPS) Leads’ Compliance Programs. It replaces DSRIP Compliance Guidance 2015-01 that was posted on April 6, 2015. The DSRIP Compliance Guidance is specific to DSRIP program mandatory compliance programs that must be in place for PPS Leads. It notes that PPS Leads must meet all of the mandatory compliance program obligations set out in New York Social Services Law Section 363-d and 18 New York Code of Rules and Regulations Part 521. DSRIP Compliance 12

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Guidance 2015-01 Revised sets out some special considerations that PPS Leads should work into their compliance programs. The DSRIP Compliance Guidance is available on OMIG’s website at https://www.omig.ny.gov/dsripcompliance-guidance. In July, OMIG posted a DSRIP Guidance Frequently Asked Questions at https://www.omig.ny.gov/images/ stories/compliance_alerts/20150715_dsrip_faqs.pdf.

Managed Care Roundtable and New Counties for Transportation Carve-Out The U.S. Centers for Medicare and Medicaid Services (CMS) and state Department of Health (DOH) will convene a roundtable for plans and providers on the Fully Integrated Duals Advantage (FIDA) program on September 17 and September 30, from 10 a.m. to 1 p.m. Both events will provide the same content and be held at the CMS Regional Office in Manhattan: 26 Federal Plaza on Broadway between Duane and Worth Streets. There is no call-in option for the meeting. Providers and plans must RSVP at the following links: •

RSVP by September 14, 2015 for the Thursday, September 17 training at https://www.eventbrite.com/ e/fully-integrated-duals-advantage-fida-provider-training-tickets-18214454925.

•

RSVP by September 25, 2015 for the Wednesday, September 30 training at https://www.eventbrite.com/ e/fully-integrated-duals-advantage-fida-provider-training-tickets-18334242212.

Transportation Carve-out for Additional Managed Care Enrollees DOH’s phase-in of a Medicaid fee-for-service non-emergency medical transportation (NEMT) management program, under which transportation services are carved out of the Medicaid managed care benefit package, will include Nassau and Suffolk counties, effective December 1. LogistiCare Solutions, LLC was selected as the NEMT management contractor for Nassau and Suffolk Counties and can be contacted at 844-678-1106 (provider) or 844-678-1103 (consumers). The first NEMT program for managed care enrollees was implemented in the Hudson Valley Region in January 2012, with additional Hudson Valley counties moving to the NEMT manager in March and September of 2012. Implementation in New York City began in January 2013. An additional 24 counties in the Finger Lakes and Northern New York moved to the NEMT manager on January 2014, and 7 Western New York counties were transitioned to the NEMT manager on January 1, 2015.

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Volume 20, No. 30 September 4, 2015 

NHTD/TBI Stakeholder Group Meets Last week, the state Department of Health (DOH) held its first meeting of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver Transition Workgroup. The Workgroup was established as part of an agreement to delay the transition of the NHTD and TBI waiver programs to managed care until January 1, 2017. The group was developed to discuss issues and make recommendations related to the transition. At the meeting, DOH explained the various procedures for moving a program and its recipients into managed care, including a transition plan, network adequacy, appeal rights, education and beneficiary notices while CMS discussed its oversight role. The stakeholder group – comprised of service providers, consumers, advocates and plans – raised a number of issues including: whether all waiver services should be benefits under managed care; any necessity for extra protections to ensure that enrollees are not unnecessarily institutionalized; differences between service coordination and care management; access to behavioral health services for NHTD/TBI consumers; and others. The group agreed to set up subgroups to address service access; workforce; financial incentives to keep consumers at home; housing; and education/outreach. A draft timeframe of meetings and milestones in the process includes the following: additional workgroup meetings are planned for November 18 and January 27, 2016; a draft transition plan would be given to the workgroup at its January 27 meeting; a draft transition plan would be released to the public on April 1 with a 30-day comment period; a final transition plan would be submitted to CMS on June 30, 2016 with CMS action by November 30, 2016. If CMS approval is obtained, general announcement letters will be sent to recipients by December 15, 2016. A “sixty-day” notice that informs consumers about the changes and gives them sixty days to choose a plan or face auto enrollment will be sent by January 1, 2017 followed by a “thirty-day” notice on February 1, 2017. Those who do not select a plan will be auto assigned to a plan on March 1, 2017 with their enrollment effective April 1, 2017. Materials from the workgroup meeting are at http://www.health.ny.gov/health_care/medicaid/redesign/ mrt_90.htm. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

DOH Releases May 2015 Global Cap Report Home care and personal care spending slightly above projections The state Department of Health (DOH) has issued its May 2015 Medicaid Global Spending Cap Report. It shows overall spending to be $18 million less than projected for the current fiscal year through May. (The current state fiscal year began on April 1, 2015 and ends March 31, 2016.) The actual spending amount for this two-month period was $3.577 billion versus an estimated spending amount of $3.595 billion. The cap for the entire fiscal year is $17.7 billion. Continued on next page

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Volume 20, No. 30 September 4, 2015 

 Continued from p. 14 The May report can be accessed at http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/ monthly/sfy_2015-2016/docs/may_2015_report.pdf. For reporting purposes, home care and personal care services continue to be lumped into the category labelled “Other Long Term Care.” According to the report, that category was $11 million above projections for the second month of 2015-16 – a difference between projected spending of $110 million and actual spending of $121 million. The report states that the $11 million in spending over projection was a result of more recipients billed than anticipated in personal care (5.1 percent more). The Accounts Receivable (A/R) ending balance for fiscal year 2015 was $280 million. The state is expected to recoup $170 million by the end of fiscal year 2016, resulting in a projected A/R balance of $110 million by March 2016. Through the end of May, retroactive rates owed to the state were $686 million. This reflects an increase of $406 million since March 2015. Medicaid total enrollment reached 6,218,471 enrollees at the end of May 2015. This reflects an increase of 47,405 enrollees, or 0.8 percent, since March 2015. As noted in previous ASAP articles on the Medicaid Global Cap, HCA has expressed concerns to DOH about the impact of retroactive payments on the global cap. 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.

CAHPS Hospice Survey Training Registration Now Open The U.S. Centers for Medicare and Medicaid Services (CMS) will offer a free webinar training on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey on September 30, 2015, from 11:30 a.m. to 4:30 p.m. This training session is intended for hospices as well as their survey vendors. Training materials as well as the newly revised CAHPS Hospice Survey Quality Assurance Guidelines V2.0 will be posted on the CAHPS Hospice Survey website (www.hospicecahpssurvey.org) in late September 2015. To register for the webinar, visit http://www.hospicecahpssurvey.org/Content/TrainingForm.aspx. The deadline to register is September 17, 2015. The CAHPS Hospice Survey Training session is required for all survey vendors conditionally approved to administer the CAHPS Hospice Survey. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

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Volume 20, No. 30 September 4, 2015 

Medicare Advantage Value-Based Model Announced This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the launch of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model which will test the hypothesis that giving Medicare Advantage (MA) plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing to enrollees who have specified chronic conditions can lead to higher-quality and more cost-efficient care. These new supplemental benefits may include the elimination of co-pays for eye exams for beneficiaries with diabetes or extra tobacco cessation assistance for enrollees with Chronic Obstructive Pulmonary Disease (COPD). Targeted enrollees, however, can never receive fewer benefits or be charged higher cost sharing than other MA enrollees as a result of the model. Other conditions targeted are: Congestive Heart Failure (CHF); patients who had a stroke; hypertension; Coronary Artery Disease; and Mood disorders. The MA-VBID model will begin January 1, 2017 and run for five years. CMS will test the model in 7 states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. According to CMS, these states were selected in order to be generally representative of the national Medicare Advantage market; they include urban and rural areas, areas with both high and low average Medicare expenditures, high and low prevalence of Low-Income Subsidies and areas with varying levels of penetration of and competition within Medicare Advantage. Test states have also been selected based on the availability of appropriate paired comparison areas for the purposes of evaluation. More information is at http://innovation.cms.gov/initiatives/VBID/.

Changes in Billing Home Care Services in OPWDD Residences On October 1, 2015 changes in reimbursement will affect the following services through the Office for People With Developmental Disabilities (OPWDD) Comprehensive Home and Community Based Services (HCBS) Waiver: personal care services, home health aide (HHA) services, homemaker services, consumer directed personal assistance programs (CDPAPs), and supplemental day habilitation. Effective October 1, 2015, OPWDD has changed the reimbursement methodology for certain services for people who live in Supervised and Supportive Individual Residential Alternatives (IRAs), Community Residences (CRs) and Family Care (FC) Homes. Information is in the August Medicaid Update at http://www.health.ny.gov/health_care/medicaid/program/ update/2015/august15_mu.pdf.

Care At Home and Medical Indemnity Fund The state Department of Health (DOH) has issued guidance to clarify that a child enrolled in the Care at Home III, IV and VI Waiver Programs can also be enrolled in the Medical Indemnity Fund at the same time. The instructions are at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/ 15ma016.pdf. Continued on next page

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Continued from p. 16 The Medical Indemnity Fund (“Fund”) is designed to pay all future costs necessary to meet the health care needs of plaintiffs in medical malpractice actions who have received either court-approved settlements or judgments deeming the plaintiffs’ neurological impairments to be birth-related. The Fund will cover or reimburse the cost of health care services, supplies, equipment and medications that the Fund enrollee’s physician, physician assistant or nurse practitioner has determined are necessary to meet the Fund enrollee’s health care needs. In general such costs include: medical treatment, hospital care, nursing, dental, medications, assistive technology, durable medical equipment and other costs. DOH has determined that a child can remain in the Care at Home III, IV and VI Waiver programs at the same time as enrollment in the Fund, but the Fund is the primary payer for Fund covered services. Please note that CAH case management services are not covered by the Fund and will continue to be billed directly to Medicaid. Disability Team Review Certificate DOH has also released instructions on LDSS-639 Disability Team Review Certificate and the Care at Home Waivers III, IV and VI. The information is at http://www.health.ny.gov/health_care/medicaid/ publications/docs/gis/15ma016.pdf. Questions can be directed to Lynda Baum-Jakubiak, Statewide CAH Coordinator at 518-474-6466.

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be closed on Monday, September 7. This includes the following departments: Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Reopening Unit. Electronic claim files transmitted after 5 p.m. on September 4 will have a claim receipt date of September 8. Providers will be able to access NGS Connex and use the Interactive Voice Response (IVR) system at 1-866-275-3033. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Publications •

“Office of Inspector General Advisory Opinion” regarding a home health provider’s policy to offer free introductory visits to certain patients http://oig.hhs.gov/fraud/docs/advisoryopinions/2015/AdvOpn15-12.pdf

•

“Special Housing Disregard for People Returning Home from Nursing Homes or Adult Homes and Enrolling in MLTC Plans,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/212/

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

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HCA’s Senior & Financial Manager’s Retreat September 17 & 18, 2015 Mohonk Mountain House, New Paltz, NY

1 “CHHA Medicaid EPS rebasing cuts are here, and more cuts are coming. TPL and F2F are weighing on our bottom line. We’ve hardly got our head around DSRIP – and now the state is moving to value-based payments. Meanwhile, our accounts receivable is through the roof, and it feels like we’ve exhausted all potential growth opportunities.”

Are these the kinds of thoughts keeping you up at night? Come to

HCA’s Senior and Financial Manager’s Retreat

September 17 and 18

to get away – and to get a better grasp of today’s home care payment and regulatory environment.

We’ll help you put your budget in square order, find the answers you need from top officials and contractors, and gain valuable insights from the state’s leading consultants who will reveal what they are telling their clients about where to look for new opportunities. HCA is offering this program in

4

critical domains: The Big Picture, Reimbursement Mechanics and Updates (Medicaid and Medicare), Strategic Planning for New Growth Areas, and A Medicare Focus. Details are fleshed out later in this brochure.

Big Picture

Mechanics

Growth

Medicare Focus

Also, did we mention that this is all taking place at one of the nation’s top-ranked resorts, conveniently located in the Catskills? If you’ve been to this retreat before – at the scenic Mohonk Mountain Resort in New Paltz – you know it’s the right place to get informed and inspired. With your hotel and conference registration, we have you covered: expert presenters, all meals at Mohonk’s world-class dining facilities, an evening reception to network, access to the resort’s trails and picturesque grounds, and months-worth of insights in two days. You just need to reserve your spot.

Please register by September 11 to get your seat at the table. And while you are at it, why not make it a ‘table for two’? Bring your CEO, chief finance officer or finance directors for shared learning and strategic planning.

2 Conference Sessions September 17 (9:15am to 4:45pm) September 18 (8:30am to noon) Big Picture

Growth

Domain I: The Big Picture • HCA’s Policy & Executive Team – Sept. 17 Let HCA’s policy and executive team set the stage for you. We’ll give you the latest info from Albany and Washington. We’ll tell you what we are doing to shape the payment and regulatory environment in a way that mitigates risk and opens new opportunities. Best yet, we’ll answer your questions on any reimbursement, payment or regulatory issues needing clarification.

Mechanics

Domain II:

Reimbursement Mechanics and Insights (Medicaid & Medicare) • DOH Reimbursement Updates (Tim Casey and Dan Carmody) – Sept. 17 • New Developments in TPL (Erin Devaney and Jennifer Kasper, UMASS) – Sept. 17 The timing of this conference couldn’t be better: DOH will be finalizing its CHHA rebasing rates in October, just a few weeks after the Retreat. You’ll get the most up-todate preview of the state’s intentions for resetting the CHHA reimbursement system – not to mention countless other Medicaid reimbursement, MLTC, FIDA and managed care updates that all home care programs need to know about. We don’t need to tell you that TPL billing and audits have been a major unreimbursed assignment for home care agencies across the state. Things may be changing. For instance, what does the future hold, now that much of the state’s dually eligible population has moved into managed care? TPL occupies a big space in your administrative budget; you’ll want to know what’s coming next from OMIG and its TPL contractors.

Domain III:

Strategic Planning – Inside and Outside the Government Payor Box • A Changing Health Care Landscape – Perspectives and Insights from the Health Plans (Kathleen Preston, NYHPA) – Sept. 18 • Panel Discussion on Plan, Physician Practice, Hospital/HomeCare (Sean Doolan, Principal at Hinman Straub P.C.; Dr. Andrew Kleinman, Immediate Past President of MSSNY; Daniel Rinaldi, Vice President Financial Services and Chief Financial Officer at Ellis Hospital)– Sept. 17 • New Business Lines in Evolving Market Places (Carla Williams, O’Connell and Aronowitz) – Sept. 17 We know you need more answers about all of the new payment models on the horizon, as well as growth opportunities that cut across payor lines. Ms. Preston, a key policymaker working on behalf of managed care plans, will offer perspectives on the issues, challenges and opportunities health plans are facing in the roll-out of DSRIP, Value Based Payment and other new models. She’ll also share insights on how home care providers can play a role in these new models of care, working positively with plans. HCA also knows there are value and growth areas that may seem hidden to you – and we have top experts to present these insights, including a panel who will discuss innovative arrangements with plans, physicians and hospitals. In addition, a health care industry expert will be here to help you explore growth opportunities in new business lines to diversify your portfolio.

3 Conference Sessions September 17 (9:15am to 4:45pm) September 18 (8:30am to noon)

Medicare Focus

Domain IV: A Focus on Medicare • Maximizing Your Medicare Revenues Through Improving Operations and Benchmarking (Michael Freytag, Black Tree Healthcare Consulting) – Sept. 17 • Federal Update on F2F, Regulatory Issues and Reimbursement (Bill Dombi, NAHC) – Sept. 18 You’ve been benchmarked! It’s how Medicare and Medicaid rates are set; it’s even how auditors decide who to target for review. But you can also use benchmarking to your advantage. You just need the data, and a little insight. While HCA has substantially built up our capabilities in this area, through our HCA Data page and other resources, a lot of this data gathering and analysis has also been done for you by expert consultants and benchmarking analysts. Enter Black Tree Healthcare Consultants, who will show you the most important Medicare comparative data to set your compass right. NAHC’s Bill Dombi is one of the sharpest and most knowledgeable voices on Medicare home health – bar none. We are delighted that he is available to present some very practical insights on evolving guidance related to the face-to-face requirement, Medicare rebasing and other major payment issues affecting the Medicare side of your operation.

Big Picture

Mechanics

Growth

Medicare Focus

4

Thanks to our Sponsors and Exhibitors! Mohonk Mountain House Rates and Other Information Your combined hotel and registration rate includes your room, all meals, breaks, valet parking and meeting amenities. A single room rate is

$305 per person, per day; double rates are $229 per person, per day. Local taxes and a 12% gratuity are additional. All Mohonk reservations should be made by August 15 to receive the HCA conference rate and be guaranteed a room. After this date, higher rates will apply based on availability.

Call 800-772-6646 and ask for the HCA rate.

Not Staying Overnight at Mohonk? Since this is a remote resort in the mountains, and Mohonk wants to also be prepared for those not staying overnight, a “per-day rate� of $120 is

charged. This day rate includes lunch, breaks, meeting amenities, and self-parking. Day guests must register with HCA as well in order to access the property. Please include the fee(s) with your HCA registration (next page).

Senior Financial Managers Retreat September 17 & 18, 2015 Mohonk Mountain House The registration fee of $299 for HCA members includes two days of expert speakers and handout materials, plus breaks, a reception and lunch on the final day that is not included with your room package. Potential members are also welcome at the rate of $399 per person. Mohonk Resort rooms/meals are additional – see page 4.

REGISTRANT INFORMATION – Please register by September 11. Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

HCA REGISTRATION FEE ____ Member Fee

 $299

____ Non-Member Fee

 $399

MOHONK RESORT FEES Check one of the following. See resort information and pricing on page 4 for details.

____ I will make my overnight room reservation directly with Mohonk.

 $0

____ I require a Mohonk “day only” pass at $120 per day.

 $_________

PAYMENT – Please check method of payment: ________MasterCard

_______VISA

Total:

$___________

______American Express

______Check*

*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by September 11. ______________________________________________________________________________ Card Number _______________________________________ _______________________________________ Expiration Date Security Code

______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card ______________________________________________________________________________ Authorized Signature

FAX this form to 518-426-8788 or register online at www.eventville.com/hcanys

HCA Cancellation Policy HCA registration cancellations received by August 28 are refundable less a 25% administrative fee. No refunds will be issued after this date.

Cancellations must be received in writing at info@hcanys.org. Substitutions are permitted. Please note Mohonk’s cancellation policy when making your reservation.

Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________