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ASAP

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

Legislative Issues  Public Policy

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News

Volume 20, No. 35 October 9, 2015

OMIG Convenes Workgroup on MLTC; HCA a Member The state Office of the Medicaid Inspector General (OMIG) has convened a workgroup to explore regulatory and program audit issues related to MLTCs. HCA, as well as our MLTC and home care provider members, are participants in the new workgroup. See OMIG p. 5

Legal Developments, Media Spotlight & HCA Education Center on Home Care Wage and Market Issues U.S. Supreme Court denies “stay” pending overall review of NAHC’s “companionship exemption” appeal Among several new developments this week in the home care labor arena, the biggest, of course, was a decision by U.S. Supreme Court Chief Justice Roberts denying a “stay” in the implementation of changes to the “companionship exemption” for home care employers nationally. See WAGE p. 2

Inside ASAP

Offices Closed: HCA’s offices will be closed on Monday, October 12.

OMIG Convenes Workgroup on MLTC; HCA a Member.....................1 Spotlight on Home Care Wage and Market Issues..............................1 Funding Targeted to CDPAS Services Due to FLSA Changes.............4 QIVAPP Update....................................................................................5 HCA Meet-Ups Coming to You............................................................6 Don’t Forget: HCA’s Member Forums..................................................6 Member Hiring Announcements..........................................................7 HCA Symposium Focuses on Quality in Contract Relationships.........8 Memos Provide NGS Home Care, Hospice Advisory Updates...........8 Star-Rating Preview Reports Posted....................................................8 Managed Care Update........................................................................9 Webinar Held on ‘Opt-Out’ Procedure under DSRIP.........................10 CSC Offers Billing Seminars and Webinars........................................10 CMS Posts Question on Physician Orders and ICD-10 Transition....11 Flu Surveillance, Reporting Requirements Posted............................11 HCA Partnering with IPRO, Sepsis Alliance on CMS Innovation.......12 Olmstead Housing Subsidy Program Announced.............................13 NYACH Announces Funds to LHCSAs for Aide Training Programs..13 NYSHealth Launches 2016 Special Projects Fund RFP.......................14 OPWDD Holds Symposium on Strategies for the Future...................14 Publications.........................................................................15

The state’s new Medicaid Inspector General Dennis Rosen addressed attendees at HCA’s Corporate Compliance Symposium in Albany yesterday. Other state officials and compliance experts also presented, including the state Department of Health, which said it is soon conducting targeted offsite surveillance/ audits in the following five areas: clinical records; emergency preparedness and Health Commerce System; personnel records (including flu vaccine or masks); quality assurance and complaint review; and home health aide training program quality assurance monitoring. DOH intends to first send out a letter informing providers of these new activities which it hopes to test in the next quarter. HCA members are advised to ensure that their policies and procedures are up to date in these (and other) areas.

Helping New Yorkers Feel Right At Home

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ASAP – a publication of the Home Care Association of New York State WAGE from p. 1 This decision, reported to members in an e-mail alert on Tuesday, means the new federal wage requirements will go into effect next week – on October 13 – pending further litigation in the nation’s highest court. As extensively reported to the membership, the National Association for Home Care and Hospice (NAHC) urged the “stay” while it has separately filed an appeal with the Supreme Court seeking an override of the U.S. Court of Appeals’ decision that ruled in favor of the “companionship exemption” changes.

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The Supreme Court has previously ruled against similar rule changes – most historically during the unanimous 9-0 Coke decision in 2007 – but this is a different court, a different political environment, and a different case. HCA will forward all relevant reports from NAHC as its appeal is pursed in Washington. VNSNY takes up FLSA issue in Huffington Post

Those changes, under a U.S. Department of Labor rule, prohibit home care agencies from using the “companionship exemption” of the Fair Labor Standards Act (FLSA), resulting in higher pay and overtime for home care aides nationally. (In New York State, the impact will mean higher overtime requirements, specifically, as well as new recordkeeping for live-in cases; under New York State labor law, regular wages for home care aides and other employees already exceed baselines established by the FLSA, in some cases more so than others, as in the Wage Parity Law regions.)

In an excellent op-ed on this issue in the Huffington Post, Marki Flannery, Executive Vice President and Chief of Operations at the Visiting Nurse Service of New York, calls the soon-to-beimplemented “companionship exemption” regulations “a classic example of good intentions gone awry.” Noting her organization’s work to provide competitive wages, she adds: “In recent years, however, this has become steadily more difficult, as both Medicare and Medicaid have reduced their reimbursement levels for home health services.” “While the desired effect of the regulation … is laudable, it is missing one essential ingredient: a mechanism to pay for the increased cost,” she writes, adding that the result, “sadly, will be exactly

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

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

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the opposite of what was intended: Home health aides across the U.S. are likely to end up working fewer hours and earning less total income, while patients will have to endure fragmented care. We could even see a number of home healthcare agencies go out of business.”

Home Care Bootcamp program. This coming installment of the series is called Staying Ahead of Changes in the Labor Law, on October 13 in New York City. At the same time that “companionship exemption” changes are taking hold, the U.S. Department of Labor has proposed another, separate, rule to raise the threshold for determining whether certain “white collar” workers (executive, administrative and professional employees) fall under the minimum wage and overtime pay protections of the FLSA.

You can read the full article at http:// www.huffingtonpost.com/marki-flannery/homehealth-aides-and-the_b_8185786.html, or on HCA’s Facebook page, where we encourage you to “Like” the article, at www.facebook.com/HCANYS. Conference Call, Survey and Advocacy To prepare members for the impending FLSA rule implementation, HCA today held a statewide member conference call where HCA Counsel Frank Fanshawe, of Wilson Elser Moskowitz Edelman and Dicker, discussed the implications of the rule for home care wages and record-keeping. As stressed during the call, HCA is working to quantify the impact of this rule to support our advocacy for appropriate payment – i.e., the “essential ingredient” echoed in Ms. Flannery’s Huffington Post article: “a mechanism to pay for the increased cost.” If you agree, as we do, that this “essential ingredient” is needed, please answer a short survey that HCA and allied associations recently circulated, via e-mail alert and in recent editions of ASAP. You should have seen this survey already, in your inbox. We ask that you answer it as soon as possible, and no later than next Friday, October 16. The survey link is at https://www.surveymonkey.com/r/FVG89PH. Meanwhile, the state Department of Health has already announced overtime funding for fiscal intermediaries who provide consumer directed personal assistance services (see separate p. 4 story) and we need your feedback on overtime costs to advocate for funding for agencies who employ their own aides. October 13 Labor Law Program Mr. Fanshawe is also tapped to focus on yet another development in home care labor law, during HCA’s next 3

The threshold, affecting home care and all other employees alike, would be raised from $455 a week ($23,660 a year) to about $970 a week ($50,440 a year) in 2016 and then be updated annually, so that workers with higher incomes would be covered by minimum wage and overtime rules. HCA’s October 13 program will help you identify which home care agency staff could be affected by this proposed rule and what actions your agency should take now to prepare for the changes. (The program will also include a New York City official giving an update on New York City’s paid sick leave law.) Visit our Education and Event page for registration details at http://hcanys.org/events-education/upcomingevents. Home care market impacts of other wage changes As these labor law changes are happening directly in the home care space, the state has recently moved to raise the minimum wage in a different industry, fast-food, where workers must be paid $15 per hour under State Wage Board regulations recently promulgated by the state’s Labor Department. HCA is carefully watching these developments – which are akin to the

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

Wage Parity Law in New York City – with an eye toward the ripple effects for home care, both directly and indirectly. As the Albany Times Union reported this morning (“Minimum pay hike and a mass exodus”), the “issue of a $15 an hour mandate for fast food workers emerged Thursday during a legislative health care hearing,” where it was noted that “nursing homes and home care agencies are concerned they will lose employees” as a result of wage changes elsewhere. Asked about the trend yesterday, HCA Communications Director Roger Noyes said, in the article: “We have heard some concerns about recruitment issues in home care stemming from market forces at play, such as wage changes in other industries,” noting HCA’s repeated calls for Medicaid reimbursement policies that meet the need to support wages for a qualified home care workforce, whether under wage parity or the soon-to-beimplemented FLSA rules. Please be sure to keep informed of these developments – in home care directly or indirectly – and be sure to participate in our FLSA survey and dedicated education programming on labor law issues. For more information, please contact a member of HCA’s Policy staff.

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FLSA Funding Targeted to CDPAS The state Department of Health (DOH) has notified fiscal intermediaries who provide Consumer Directed Personal Assistance Services (CDPAS) that they may be eligible for funding to help them meet increased overtime costs due to the soon-to-be implemented Federal Labor Standards Act (FLSA) rule that eliminates the “companionship exemption” for agencies and will increase overtime costs for aides. (See related p. 1 story.) The money ($2.5 million) is available under the federal Balancing Incentive Program (BIP) and is the second payment of a similar amount that was distributed earlier this year. The application is due November 2 and is at http://www.health.ny.gov/health_care/medicaid/redesign/ mrt_61.htm. HCA has been advocating that the state also make funding available to home care providers who are directly providing aide services (in addition to CDPAS) to help them meet new overtime costs from the FLSA rule. That rule is expected to be implemented October 13, barring further legal action. HCA, along with LeadingAge NY and the New York State Association of Health Care Providers (HCP), have sent you a survey to quantify the impact of these changes and we ask that you complete it by Friday, October 16. The survey is at www.surveymonkey.com/r/FVG89PH. The short seven-question survey will take only a few minutes to complete, but will provide us with vital ammunition to advocate for increased Medicaid fee-for-service rates and premiums to managed care plans to help home care providers meet the new overtime cost. Separately, DOH is also surveying MLTC plans to ascertain the amount of new costs that their home care providers will incur under these changes; thus, members may also be surveyed by their plan contractors. As covered in numerous past editions of ASAP, BIP provides New York and other states with enhanced federal Medicaid funding to provide increased non-institutional long term services and supports (LTSS) to Medicaid recipients. As part of BIP, states must implement three structural changes in LTSS including: 1) “conflict-free” case management; 2) a no-wrong-door singleentry-point system; and 3) a core standardized assessment instrument. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

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OMIG from p. 1 The workgroup met for the first time today reviewing the workgroup’s goals, OMIG eligibility audits, program integrity provisions of the MLTC contract, prompt payment, MLTC plan stability, and further activities. A draft OMIG working paper outlining some of the draft OMIG MLTC review areas was distributed to the group. See http://hca-nys.org/wp-content/uploads/2015/10/OMIGMLTCreviews.pdf. Today’s meeting falls a day after the new Medicaid Inspector General, Dennis Rosen, and his team, including his deputy, Tom Meyer, addressed members at HCA’s Corporate Compliance Symposium on Thursday. The Symposium spoke to a range of compliance issues in home care – with other speakers from consultant groups and government regulatory offices – giving OMIG staff and other compliance officials a further understanding of the issues facing our membership. HCA and its MLTC and home care members have been urging clarity and alignment in state regulatory and procedural requirements as they relate to MLTC-home care services enrollees and service delivery. For the past several years, HCA has been working directly with the state Department of Health to promote sorting, clarifying and streamlining of roles and requirements to foster seamless and efficient delivery of services and operations under the MLTC-home care model, and to eliminate conflicts and duplication, noting, among our arguments, that the existing structure or regulations are counter-productive to compliance. The OMIG workgroup is in no small part a response to our calls for regulatory reform and audit clarity. At today’s workgroup meeting, HCA raised the regulatory “non-alignment” issue and its adverse impact on both plans and providers. OMIG specifically asked HCA to speak to the issue of delays in claims payments to home care providers and problems in obtaining initial and subsequent authorizations. In addition to improvements in these areas, HCA will also look to achieve clarity on Medicare billing/thirdparty liability requirements, and other areas of state regulations under a capitated/contracted/multipartner delivery structure (such as under MLTC), versus under fee-for-service. HCA, plans and providers have constantly asserted that much of the fee-for-service regulatory structure does not match or fit the goals of the managed care/capitation model. HCA and other workgroup members were asked to submit written comments by October 23 on the OMIG draft document. HCA will be actively reaching out to the general membership for further input into this process, and will otherwise keep members closely apprised of the developments. For further information, please contact Al Cardillo acardillo@hcanys.org or Andrew Koski at akoski@hcanys.org.

QIVAPP Update The state Department of Health (DOH) expects to soon determine, on a preliminary basis, the managed care plans and their contracted home care providers that are eligible for the second round of Quality Incentive Vital Access Provider Pool (QIVAPP) monies in New York City. As mentioned in last week’s ASAP, DOH has contracted with IPRO to conduct audits (desk and onsite) of those home care providers who have been identified as eligible for this round of QIVAPP. Prior to the completion of the audits, DOH will make initial determinations on which plans and providers will receive such funding. Continued on next page

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Continued from p. 5 DOH has informed us that some providers who did not receive initial QIVAPP funding may be awarded funds under this round, and this distribution will affect the amount of funding that was already awarded to some providers under round one. HCA will provide additional information once we obtain it.

HCA Meet-Ups Coming to You, and a Request about Your DSRIP PPS Work! HCA’s first Regional Meet-Up meetings are coming very soon, starting in Rochester and Utica on October 22, followed by Patchogue (11/5), New York City (11/5) and Westchester (11/6). As you know, these Meet-Ups are bringing HCA’s team to your region for a focus on how the DSRIP networks and other payment models are working for you. We’ll use your feedback for future advocacy while also opening the floor for other payment or service issues affecting your region. These meetings are free of charge. Please RSVP, and let us know you’ll be at a Meet-Up location closest to you, by completing the online form at https://www.surveymonkey.com/r/HCAmeetups. No, not another survey ... just tell us who your lead DSRIP PPS staffer is HCA has already heard several stories about the work of home care members on DSRIP regional planning committees. Some truly great innovations are bubbling up within your organizations, but we need to learn more as we prepare for the Regional Meet-Ups, and as we continue to develop informational resources on DSRIP generally. One current area of focus is an analysis of home care’s position under DSRIP, with specific attention to the project areas selected by each regional PPS as they relate to the provision of home care services. To further inform this effort, we have one simple question: Is your agency engaged in PPS activities in your area (i.e. regional planning committees or subgroups)? If so, please e-mail HCA’s new policy staff person, Alex Blais, at ablais@hcanys.org with the name and contact information of the individual(s) from your agency who are most directly involved in these efforts. Alex will follow-up with them directly once she hears from you, as she works to compile information on the larger scope of home care DSRIP participation. While you are e-mailing Alex, please also be sure, again, to sign up for one of our Regional Meet-Ups to further the discussion!

Don’t Forget: HCA’s Member Forums In addition to our Meet-Ups, HCA is continuing our series of Member Forums for specific segments of the HCA membership. These forums provide a custom-tailored focus on issues affecting LHCSAs, LTHHCPs and MLTCs. We’ve designed these forums recognizing that each subset of our membership has a unique scope of technical issues and advocacy needs that demand our attention. To register, download the form at http://hca-nys.org/wpcontent/uploads/2015/09/HCA-Combined-Forum-Registration-Form-2015.pdf and pick a forum meeting (or

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more than one) that you would like to attend based on the program area that represents your agency or health plan type. For MLTCS, our MLTC Forum is coming first, on October 30; our LTHHCP Forum is on November 1; and our Downstate LHCSA Forum is on November 23.

VP Chief Financial Officer at Strong Home Care Group

HIRING

Leads and manages operations that drive the financial performance for Strong Home Care Group (SHCG), including Visiting Nurse Service of Rochester and Monroe County (VNS), Community Care of Rochester (CCR) – dba Signature Care, Finger Lakes Visiting Nurse Service (FLVNS) and Finger Lakes Home Care (FLHC). Proactively provides oversight and leadership to all financial activities of the combined agency that maximizes reimbursement, controls costs, and fully utilizes agency resources. Additionally provides executive management oversight for Information Technology Services and selected support operations as assigned by the CEO. “PLEASE VISIT www.vnsnet.com FOR A FULL DESCRIPTION” Qualified candidates please send résumé to: Human Resources, 2180 Empire Blvd., Webster, NY 14580 Fax: 585-787-8369; Email: employment@vnsnet.com. VNS values diversity and encourages minorities to apply. E.O.E.

Chief Financial Officer & Director of Business Development and Marketing The Visiting Nurse Service of Northeastern New York is a dynamic, progressive home health organization dedicated to delivering the highest quality level of care through industry best practice. The 195 employees of VNS deliver skilled healthcare in the Capital District. VNS has openings for two positions: CFO: The CFO reports to the CEO and serves as an integral member of the senior management team. The right candidate will provide the leadership, management and vision necessary to ensure that the agency has the proper operational controls, administrative and reporting procedures, and people systems in place to effectively grow the organization and to ensure financial strength and operating efficiency. This position will provide useful financial insights to help make better decisions about formulating and executing strategy. Requirements: Bachelor’s degree from an accredited university or college; finance background, federal government reimbursement experience and an MBA in Accounting, Finance or Business are preferred; minimum of 10+ years of experience in senior level finance management; progressive knowledge of current financial and accounting computer applications; excellent verbal, analytical, organizational and written skills. The Director of Business Development and Marketing plans, organizes, directs, and provides the leadership to achieve the agency’s business development and marketing objectives. The position is responsible for providing leadership and direction throughout the sales and marketing function, and successfully directs the resultant business through the admissions process. The candidate develops and sustains strong relationships with agency, network, and hospital system providers to support growth and patient care objectives; and oversees the work of the Intake Coordinator and Liaisons who monitor and evaluate referral trends, market shifts and specialty service needs to assure highest levels of service delivery and to track and anticipate future program requirements and opportunities. In conjunction with Intake, this position develops strategic marketing plans to realize objectives of growth and promoting the exceptional care provided by the VNS; has ultimate responsibility for meeting goals and objectives of marketing plans; assures the development of action plans for Marketing and Sales positions that are effective and efficient; executes annual marketing, development and communication plans; conducts direct one-on-one follow-ups; and develops and maintains relationships with managed care organizations and networks, physicians, hospitals and other real or potential referral sources and business partners. Requirements: Experience in healthcare marketing or related field with an entrepreneurial perspective and a proven ability to get to ‘yes’. Bachelor’s degree required. Send résumé and cover letter for either position to: Fax: 518-382-5699; E-mail: porcellik@vnshomecare.org. Human Resource VNS, 108 Erie Blvd. Schenectady, NY 12305.

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Symposium Includes Focus on Quality Imperative Under Contract Relationships HCA’s Quality Symposium on November 17 to 18 in Troy (near Albany) will include a daylong focus on the quality imperative under contract relationships – whether you are a LHCSA, CHHA or LTHHCP contracting with another home care agency or health plan. As the state’s Managed Long Term Care, DSRIP and Value Based Payment programs continue to seek partnership activities between community-based entities and payors, the quality imperative is becoming greater and greater for purposes of marketplace desirability (as you pursue relationships), payment opportunities (as you seek adequate payment under these relationships), and outcomes (as you continue to deliver the right care at the right costs for patients). This is perhaps our most ambitious Symposium yet, with sessions on the Medicare Home Health Star Rating program, a look at HCA’s first-of-its-kind quality assessment tool (now in the RFP stages for use in 2016 by providers statewide), wound care and other clinical topics, and perspectives from the state’s quality programming lead officials. If you haven’t yet done so, please check out the full agenda and register for this blockbuster program using the PDF form at the back of ASAP, or use our online registration process at http://hcanys.org/events-education/upcoming-events.

Star-Rating Preview Reports Posted Learn more about the Star Ratings, and how to improve them, during HCA’s Quality Symposium on November 17 & 18 The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week that the Quality of Patient Care Star Ratings preview reports are now available in the CASPER folders. These reports contain data that will be publicly reported on the Home Health Compare website in January 2016. The deadline to request to have the suppression of star-rating data is October 17, 2015. A suppression request should follow the directions presented in the Preview Reports. A refresh of the Home Health Compare website was supposed to occur on October 8, reflecting preview reports posted on CASPER

HCA Memos Provide NGS Home Care & Hospice Advisory Meeting Updates Late this week, National Government Services (NGS), New York’s Medicare Administrative Contractor, held two advisory meetings: one for hospice and one for home care. The meetings provided key updates on reimbursement and payment issues, upcoming education programs and a review of new sessions, medical review and appeals data, comprehensive error rate testing (CERT) findings, and more. HCA has prepared two Public Policy Memos on each of the meetings with detailed updates. The Hospice memo is available at: http://hca-nys.org/wp-content/ uploads/2015/10/ 100915NGSHospiceMtgSummary.pdf. The Home Health memo is available at: http://hca-nys.org/ wp-content/uploads/2015/10/ 100915NGSHomeHealthMemo.pdf. HCA members are urged to read the memos carefully for critical updates relevant to your organization. All HCA memos are posted online at: http://hcanys.org/category/ policy-memos. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

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in July. Some providers may see small differences for select measures, between July and the final October postings, as measures were recalculated after the dissemination of the preview reports to include any late or corrected submissions. This recalculation did not affect star rating, or any of the measures included in its calculation. Going forward, the data tables used to calculate measures for Home Health Compare will be updated before the preview reports are sent – to capture any late or corrected OASIS submissions – and then frozen until display on Home Health Compare, which will continue to be updated on a quarterly basis. Any questions about these reports can be directed to CMS at: HomeHealthQualityQuestions@cms.hhs.gov. Star Ratings Discussed at November 17-18 Quality Symposium HCA’s newly announced Quality Symposium (on November 17-18, in Troy, near Albany), will include a segment on the star ratings. Sara Butterfield, RN, the Upstate Health Care Quality Improvement Director at IPRO and one of New York State’s most knowledgeable quality innovation experts, will show the impact the Star Rating System has had on New York’s home care provider community, and steps that can be taken by agencies to improve their scores. Register for the Symposium on our website at http://hca-nys.org/events-education/upcoming-events. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Managed Care Update The state Department of Health (DOH) has posted an updated “Managed Care Benefit and Population Expansion” chart, dated September 30, at http://www.health.ny.gov/health_care/medicaid/redesign/ mrt1458_timeline.htm. One change, from a prior version, is a delay (from January 1, 2016 to April 1, 2016) of phase one voluntary enrollment of Office for People with Developmental Disabilities (OPWDD) dual-eligibles into OPWDDFIDA plans for New York City, Long Island, Westchester and Rockland. FIDA DOH provided the following updated information on the Fully Integrated Duals Advantage (FIDA) program at its monthly Managed Care Policy and Planning Meeting: •

9,065 recipients are enrolled in FIDA as of October 1, including 2,887 individuals who were “passively” enrolled on October 1.

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2,777 Interdisciplinary Team (IDT) meetings have been held.

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The ITD policy was revised on September 15, and is available at http://www.health.ny.gov/health_care/ medicaid/redesign/mrt_101.htm; additional changes to FIDA may be forthcoming as a result of the Long Term Care Forum held on September 29 (see last week’s ASAP).

Continued on next page

ASAP – a publication of the Home Care Association of New York State Continued from p. 9 •

Providers on the IDT are required to take five trainings that cover: FIDA overview, cultural competency, behavioral health, disability and recovery and wellness.

Live-In 24-Hour Care DOH reported it had sent a survey to MLTC plans seeking to ascertain their compliance with Policy No. 14.08 requiring that MLTCs and their network providers provide a rate of payment that is based on at least 13 hours of care. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Webinar Held on ‘Opt-Out’ Procedure under DSRIP This week, the state Department of Health (DOH) held a webinar on upcoming mailings to Medicaid recipients about ‘opting out’ of sharing their health information with Performing Provider Systems (PPSs) under the Delivery System Reform Incentive Payment (DSRIP) program.

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CSC Offers Billing Seminars and Webinars Computer Sciences Corporation is holding training seminars on a variety of Medicaid billing topics at various locations during October, November and December, including Binghamton, Canandaigua, Hauppauge, Lockport, Olean, Plattsburgh, Poughkeepsie and Rensselaer. Topics include: •

ePACES for DME, clinics, physicians, private duty nursing, transportation, professional, dental and institutional

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Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA)/PDF Remit Form Completion

The mailings will be done in different phases and available in multiple languages. Phase One will be sent to 700,000 Medicaid recipients statewide in late October 2015 who: 1) were eligible for Medicaid as of September 25; 2) have claims for ambulatory sensitive conditions and avoidable emergency department/inpatient utilization; or 3) are eligible for Health and Recovery Plans (HARPs).

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eMedNY website review

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Medicaid Eligibility Verification System (MEVS)

Phase Two mailings will be sent to the remaining 5 million or so Medicaid recipients in mid-February 2016 who had eligibility as of late January 2016. The mailings will be sent over a one-month period and sorted by county and zip codes. Additional future mailings will be sent to new Medicaid recipients on a monthly basis.

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New provider/new biller

The opt-out letter and form are at http://www.health.ny.gov/health_care/ medicaid/redesign/dsrip/consumers.htm. Health information that will be shared – if individuals don’t opt out – includes medical conditions, prescription drugs, doctor visits, HIV/AIDS or mental health diagnoses. Those who don’t want their health information shared are required to sign and return a form that will be mailed to them, or call the Medicaid Call Center at 855-329-8850 (starting October 16).

DOH indicates that those who opt out of sharing their health information may not be able to receive certain services developed by PPSs. 10

The schedule is at https:// www.emedny.org/training/ index.aspx. Questions can be directed to the eMedNY Call Center at 800-343-9000.

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Volume 20, No. 35 October 9, 2015 

CMS Posts Question on Physician Orders and ICD-10 Transition The U.S. Centers for Medicare and Medicaid Services (CMS) has released a new question and answer in regard to physician or non-physician practitioner orders for lab, radiology services, or any other services including Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). The question and answer are below. Q. Does CMS require updated physician (or non-physician practitioner) orders for lab, radiology services, or any other services after ICD-10 implementation? A. CMS is not requiring the ordering provider to rewrite the original order with the appropriate ICD-10 code for lab, radiology services, or any other services after ICD-10 implementation on 10/1/2015, including DMEPOS. Products and services that require a diagnosis code on the order will use ICD-9-CM codes if written prior to 10/1/2015. If the order is for a repetitive service that will continue to be delivered and billed after 10/1/ 2015, providers have the option to use the General Equivalence Mappings (GEMs) posted on the “2016 ICD-10-CM and GEMs” web page to translate the ICD-9-CM codes on the original order into ICD-10-CM diagnosis codes. This Q&A can be found at: https://questions.cms.gov/faq.php?id=5005&faqId=12625. The “2016 ICD-10-CM and GEMs” webpage is at https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html.

Flu Surveillance, Reporting Requirements Posted Flu mask requirement still not in effect yet This week, the state Department of Health (DOH) posted a “Health Advisory: Influenza Surveillance and Reporting Requirements, 2015-2016” to the Health Commerce System (HCS). Though the Advisory applies to care provided in non-home settings – home care agencies are not required to report individual cases of influenza or rapid-test results – if the home care agency staff suspects anything unusual (e.g. possible antiviral treatment failure, outbreaks, suspected novel flu), they should report it to the local health department, as covered in the “All Settings” section of the Advisory. DOH also encourages all home care agency staff who provide care to follow recommended influenza prevention and control guidelines outlined at http://www.health.ny.gov/diseases/communicable/influenza/fact_sheet.htm. DOH has not yet declared influenza to be prevalent in the state at this time, and, thus, home care and other health care providers are not required to meet the state’s flu-mask and reporting requirements. Under this mandate, certain personnel not vaccinated against influenza for the current influenza season must wear a surgical or procedure mask while in areas where patients or residents are typically present. The requirement also has a reporting component. Though this requirement is not in effect yet, agencies should now be preparing for ensuring their staff obtain flu vaccines or wear masks. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 11

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

Volume 20, No. 35 October 9, 2015 

HCA Partnering with IPRO and Sepsis Alliance on CMS Innovation IPRO, the Quality Improvement Organization (QIO) for the New York region, has been awarded federal funds for two new “Innovations” services projects focusing on strong home and community based care. The projects are a Community Based Sepsis Initiative and an End-of-Life Care Transformation Initiative. The projects will be piloted in two specific regions of the state over the September 2015 to 2017 period, with the sepsis initiative specifically including a partnership with HCA. HCA has been conducting a first-of-a-kind initiative to create a screening tool and protocol for use in home care for early recognition and intervention in possible sepsis cases. The tool, drafted by the HCA Quality Committee’s workgroup on sepsis (IPRO is a member), is completing its second round of beta testing today. The U.S. Centers for Disease Control and Prevention (CDC) highlighted HCA’s initiative and prospective implementation plan in a blog posting to CDC’s website (http://blogs.cdc.gov/safehealthcare/2015/09/10/ harnessing-home-care-in-early-sepsis-recognition/). IPRO’s project will sync with the work of HCA, the National Sepsis Alliance and the Rory Staunton Foundation, all of whom are named-partners in the project. IPRO’s project goals are to: •

Facilitate education and build awareness of sepsis among pre-hospital providers and caregivers in contact with at-risk community dwelling Medicare beneficiaries.

•

Identify best practice protocols and educate pre-hospital providers on the recognition and importance of efficient referral to the next level of care for emergent care management.

•

Improve processes-of-care transitions and care pathways with sepsis treatment between pre-hospital and hospital/emergency care setting providers and post-acute discharge to the community.

•

Increase public awareness of the signs, symptoms, and contributing factors to sepsis through community outreach, public service announcements, and social media.

A “partners” call is scheduled for next week, at which point HCA will have additional information. The second IPRO project, Transforming End-of-Life Care, will provide training and technical support to home care agencies and other sectors on adoption, training and implementation of eMOLST (Medical Orders for Life-Sustaining Treatment), which documents a patient’s preferences concerning life-sustaining treatment. The project will also address community outreach to educate New York’s Medicare beneficiaries on end-of-life planning, communication with health care practitioners about end-of-life care, documentation of treatment preferences, and preparing patients for the possibility of being unable to make their own care decisions as they enter the advance stages of chronic illness. Learn more about these and other quality initiatives in home care at HCA’s November 17-18 Quality Symposium. A registration form is at the back of HCA’s ASAP, but you can also register on our website at http://hcanys.org/events-education/upcoming-events. For further information, please contact Al Cardillo at acardillo@hcanys.org. 12

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

Volume 20, No. 35 October 9, 2015 

Olmstead Housing Subsidy Program Announced The state Department of Health (DOH) has announced funds available to establish a rental subsidy program with community transitional services (CTS) for high-need Medicaid beneficiaries. Eligible participants of the pilot program are Medicaid enrollees who: 1) are at a nursing home level of care as determined by the Uniform Assessment System; 2) are homeless or unstably housed, and have spent at least one hundred and twenty consecutive days in a nursing home over the most recent two year period; and 3) have the ability to live safely in the community. Items eligible for CTS funding include reasonable costs for some or all of the following items: • • • • •

Security deposits; Essential furnishing: bed, table, chairs, eating utensils, window coverings; One-time set up fees for services access including: electric, heat and telephone; Broker’s fee; and Mover’s expenses.

The program may not be used to subsidize placement in a congregate care setting including Assisted Living Facilities, Enriched Housing, Assisted Living Programs or Assisted Living Residences. Up to $10 million is available for a two-year contract. Applications will be accepted from not-for-profit corporations and for-profit corporations located and conducting business in New York State, and government agencies. The Request for Application (RFA) can be accessed through the Grants Gateway website at http:// grantsgateway.ny.gov under Grants Gateway No. DOH01-OHSUB-2015. Applications must be submitted online via the Grants Gateway by December 1, 2015 no later than 6 p.m.

NYACH Announces Funds to LHCSAs for Aide Training Programs The New York Alliance for Careers in Healthcare (NYACH), in partnership with SBS and the Paraprofessional Healthcare Institute (PHI), has announced a 2015-16 Quality Home Care Workforce Program, its third year, with funding for LHCSA home health aide training programs. Two partnership options are available for LHCSAs who may be awarded one, neither, or both partnerships. These include: 1. Enhanced Employer-based Home Health Aide (HHA) Training: Up to $99,999 will be awarded to selected employers interested in adapting their own training program by offering an enhanced, 120hour state Department of Health-approved home health aide training. Four employers will be chosen for this initiative and will be funded to conduct four training cohorts (each with approximately 20 participants for a total of 80 participants per employer) between November and June of 2015. Selected

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

Volume 20, No. 35 October 9, 2015 

employers will be able to partner with and utilize the Workforce1 Centers in their area to recruit, screen and select qualified candidates for the training program and post-training employment. 2. Enhanced HHA Training with the City University of New York (CUNY): An enhanced, 120-hour, state Department of Health-approved HHA training will be offered by CUNY institutions – Queensborough Community College, New York City College of Technology (CityTech) and Lehman College. Like option 1, selected employers will be able to partner with Workforce1 to recruit, screen, and select qualified candidates for the CUNY-based training program and post-training employment. Based on need and availability, selected employers may be awarded between two training cohorts (each with approximately 20 participants for a total of 40 participants per employer) and five training cohorts (for a total of 100 participants per employer). The application and program guidelines are at http://nyachnyc.org/partnership-application-for-home-careagencies-released/. Applications are due by 5 p.m. on October 14 and should be sent via e-mail to awiseman@sbs.nyc.gov.

NYSHealth Launches 2016 Special Projects Fund RFP The New York State Health Foundation (NYSHealth) has announced the availability of its 2016 Special Projects Fund Request for Proposals (RFP). Applicants must submit an online inquiry form to determine whether a proposed project fits the funding criteria. There are two deadlines for the online inquiry: November 4, 2015, and April 7, 2016. Selected organizations will be invited to submit full applications, which will be reviewed on a rolling basis with two deadlines: December 29, 2015, and May 25, 2016. NYSHealth Special Projects Fund awards are one-time, nonrenewable funding opportunities consistent with the Foundation’s mission to improve the health of all New Yorkers but outside of its main priority areas. In 2016, the Foundation’s key grantmaking priorities will be: 1) building healthy communities and 2) improving transparency and affordability to empower consumers. Details are at http://tinyurl.com/pylenky.

OPWDD Holds Symposium on Strategies for the Future The state Office for People with Developmental Disabilities (OPWDD) is holding a symposium, “Strategies for the Future: Supporting Complex Needs,” on November 5 from 8 a.m. to 4:30 p.m. in Albany. Service providers, families, policymakers and others are invited to attend. The agenda includes the following topics: • • • • • •

Maximizing technology to support transformation for complex needs Making sense of self-direction “Transforming support means transforming a workforce” Exploring options for employment and meaningful community activities Innovations in community housing Shifting service models for complex needs Continued on next page 14

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

Volume 20, No. 35 October 9, 2015 

 Continued from p. 14 Information, including online registration, is at http://www.opwdd.ny.gov/news_and_publications/ symposium. The registration deadline is October 29. Questions can be addressed to Christy Faucher at christy.b.faucher@opwdd.ny.gov or Letycia Tillman at letycia.r.tillman@opwdd.ny.gov.

Publications •

“Signature Requirements,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R615PI.pdf

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

AGENDA HCA Welcome and Introduction 9:30am

Changes in Overtime for Executive, Administrative and Professional Staff 9:45am to 10:45am

Tuesday, October 13 9:30am – 12:00Noon

Location: Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Avenues)

New York, NY

Fee: $79 for HCA Members; $139 for Non-Members Thanks to our Breakfast Sponsor:

This program will review a recently proposed rule by the U.S. Department of Labor that would raise the threshold for determining whether certain “white collar” workers (executive, administrative and professional employees) fall under the minimum wage and overtime pay protections of the Fair Labor Standards Act. The threshold would be raised from $455 a week ($23,660 a year) to about $970 a week ($50,440 a year) in 2016 and then be updated annually so that workers with higher incomes would be covered by minimum wage and overtime rules. Learn which home care agency staff could be affected by this proposed rule and what actions your agency should take now to prepare for the changes. Frank J. Fanshawe Partner Wilson Elser Moskowitz Edelman and Dicker LLP

Update on Paid Sick Leave Law for NYC 11:00am to 12:00Noon Learn the latest on New York City’s Paid Sick Leave law, including: • How the law applies to per diem (nurses and therapists) or on call workers that create their own schedules and hours; • When per diem or on call employees can use sick leave; • How sick leave accrues for employees who work for an agency that is exempt from state overtime requirements; • Interaction with collective bargaining agreements; and • Statistics on the number and type of complaints received and actions taken. Tanjila Rahman Outreach Coordinator, Paid Sick Leave Division NYC Department of Consumer Affairs

REGISTRATION – (Deadline October 6th)

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 September 29 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

$79 ________

____VISA

Non-Members

$139 ________

____ 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

HCA Regional Meet-Ups: Help Us Help You!

+ Add me

HCA is continuing our series of Member Forums for specific segments of the HCA membership. These Forums provide a custom-tailored focus on issues affecting LHCSAs, LTHHCPs, MLTCs, and HCA’s Home Care Council (HCC) of New York City members.

Registration

Once complete, please fax to (518) 426-8788. You must provide us with an email address in order to receive your confirmation. ______________________________________________________ Name

We've designed these forums recognizing that each subset of our membership has a unique scope of issue and advocacy needs that demand attention.

______________________________________________________ Title

Please register today to attend one of these important sessions.

______________________________________________________ City/State/Zip

______________________________________________________ Agency ______________________________________________________ Address

______________________________________________________ Phone/Ext.

MLTC forum October 30

11am – 2pm HealthPlus/Amerigroup 9 Pine Street 14th Floor (AKA 14 Wall Street) New York, NY 10005

LTHHCP forum November 13

10:30am – 2:30pm Hilton Albany 40 Lodge Street Albany, New York 12207

Downstate LHCSA forum November 23

10am – 2pm Selfhelp Family Home Care Boardroom 530 Eighth Avenue 5th Floor New York, NY 10018

______________________________________________________ Email (Required) Second Registrant from same organization: ______________________________________________________ Name ______________________________________________________ Title ______________________________________________________ Email (Required)

Payment of $40 per person Total $________ _______ VISA

_________ MC

_______ AM EXP

Credit Card No.________________________________________ Expiration Date:______________ Sec. Code:_______________ Card Billing Address:____________________________________ ________________________________________________________ Name on Card:_________________________________________ Signature:______________________________________________ Or, make checks payable to: HCA E&R and mail to 388 Broadway, 4th Floor, Albany, NY 12207

Lunch will be provided at each of the Forums. Please let us know if you have any dietary restrictions so that we can try to accommodate you. Cancellation Policy: Cancellations received one week prior to the forum will receive a full refund, less 25% of total due as an administrative fee. Cancellations received within one week of the forum will forfeit their registration fee, along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426-8764 or tbrown@hcanys.org to cancel.

The Quality Imperative: Raising the Bar in Home Health Care

November 17 & 18, 2015 Hilton Garden Inn 235 Hoosick Street Troy, NY 12180

www.eventville.com/hcanys

November 17 & 18, 2015 Hilton Garden Inn 235 Hoosick Street Troy, NY 12180

The Quality Imperative: Raising the Bar in Home Health Care Quality outcomes have always driven your work in home care. But today’s environment is making quality deliverables a more commanding imperative, and a linchpin for the success of your agency. CAHPS surveys, Home Health Compare, HQRP, OASIS … in many respects, these are the first legacy of quality improvement leverage points. They remain important concerns. But today, home care is faced with new and even bigger machinery for inducing quality enhancement that demand an equally vigorous response from CHHAs, LTHHCPs, and LHCSAs alike. All home care providers must focus their energies, resources and intellectual capital to understand and retool their organizations for the new quality imperative. HCA’s Quality Symposium presents an opportunity to learn the broad strokes and inner workings of New York State’s quality home care imperative. You’ll hear about concrete tools, resources and information that will arm agencies to effectively compete in this environment. You’ll also learn about interventions for specific clinical areas that align with the demands of MLTC, DSRIP, Value Based Payments and other new care models.

AGENDA

Tuesday, November 17 – Day 1 8:30am

Registration Opens with Light Breakfast

9:00am

HCA Welcome

9:00 – 10:00am

State Update on Quality & Payment Innovation Patrick Roohan, Director, Office of Quality and Patient Safety, NYS Department of Health Hear from one of New York State’s most influential and thoughtful policymakers about the plans and vision of the State in designing state policy to encourage and promote quality health care. Mr. Roohan will discuss the State’s vision for quality innovation and improvement through policy changes that will affect how all health care providers (including home care) participate in the Medicaid marketplace.

10:00 – 10:45am

HCA Quality Risk Tool Laurie Neander, Chief Executive Officer, Bassett Healthcare Network: At Home Care Al Cardillo, Executive Vice President, HCA HCA, working with key home care leaders across New York State, has formulated and developed a quality of care risk tool that is currently in the RFP stages of development. This session will offer a look at this unique HCA quality risk tool that will be available to members in 2016. It will arm agencies with a thorough, methodical tool to measure risk areas in clinical, financial and operational quality oversight.

November 17 & 18, 2015 Hilton Garden Inn 235 Hoosick Street Troy, NY 12180

The Quality Imperative: Raising the Bar in Home Health Care Tuesday, November 17 – Day 1 - continued 10:45 – 11:00am

Break

11:00am – Noon

Wound Care: There’s an App for that Nathan Ie, CEO, Co-Founder, Healogram Lorraine Poliey RN, WCC, DAPWCA, Wound Care Program Manager, Montefiore Home Care This session will offer insights on a new App designed to help providers reduce the cost of and challenges associated with wound care. Healogram enables providers to more effectively and efficiently measure, monitor, and manage wound patients. Healogram CoFounder Nathan Ie and wound care program manager Lorraine Poliey, RN of Montefiore Home Care will outline details on Healogram’s functionality and share practical insights on ease of implementation, impact on care delivery and potential for enhanced patient outcomes.

Noon – 12:45pm 12:45 – 1:45pm

Lunch

Hotel Information

Promotion of Quality in Managed Long-Term Care

Hilton Garden Inn 235 Hoosick Street Troy, NY 12180

Tracy Langlais, Vice President, Medical Affairs Operations, CDPHP As New York’s health care system evolves, health plans, including MLTCs and MCOs, feel enormous pressure to meet the highest quality outcomes and benchmarks. Aligning home care’s emphasis and priorities on quality innovations and outcomes with the benchmarks that are of utmost importance to managed care plans can lower cost and improve care for patients. Learn from one of the state’s most innovative managed care plans about its priorities for quality innovation and alignment with home care partners. 1:45 – 2:45pm

VBP Clinical Spotlight: TBA

2:45 – 3:00pm

Break

3:00 – 4:30pm

CMS Star Rating System and NYS Home Care Quality Indicators

HCA has reserved a limited block of rooms at the rate of $129 per night. To make a reservation for the evening of Monday, November 16 or Tuesday, November 17, please call (877) 782-9444 before November 2, and ask for the HCA Quality Symposium group rate.

Sara Butterfield, RN, BSN, CPHQ, CCM, Director, Upstate Health Care Quality Improvement, IPRO Learn from one of New York State’s most knowledgeable quality innovation experts about the impact the Star Rating System has had on New York’s home care provider community, and steps that can be taken by agencies to improve their scores. 4:30 pm

Wrap Up and Adjourn Day 1

Day 2 Agenda continued on next page…

November 17 & 18, 2015 Hilton Garden Inn 235 Hoosick Street Troy, NY 12180

The Quality Imperative: Raising the Bar in Home Health Care

REGISTRATION FORM Registration Deadline is November 2.

Wednesday, November 18 – Day 2 8:00am

Registration and Light Breakfast

Name: _____________________________________________ Title:_______________________________________________ Agency:____________________________________________ Address:____________________________________________

8:30-10:00am

Quality Care Values in Contracted Home Health Care Services Marki Flannery, Executive Vice President and Chief of Provider Operations, Visiting Nurse Service of New York Maureen Forster, Empire Blue Cross Blue Shield Health Plus This session will offer insights, tools, and innovative program models for enhancing the quality of your home health care services in areas valued by health plans and contracting agencies. Learn from health plan and contracting agency representatives about their current quality initiatives and the quality related indicators/ measures they are seeking in an optimal contracted Licensed Home Care Service Agency to inform your strategic planning toward sustainability and growth in an increasingly competitive service delivery environment. Attendees will have an opportunity for questions and answers with panelists.

10am – 10:15am

Break

City/State/Zip:_______________________________________ Phone:_____________________________ Ext._____________ Email: ______________________________________________ (Required)

www.eventville.com/hcanys

FEE SCHEDULE Full Symposium (Nov 17 & 18) HCA Member Rate Per Person

$259 □

HCA Member Group Rate (3 or more)

$239 □

Non-Member Rate

$339 □

November 17 Only HCA Member Rate

$199 □

Non-Member Rate

$279 □

November 18 Only

10:15am – 11am Quality Care Innovations in LHCSA Delivery James P. Rolla, Vice President, People Care, Inc. Michelle Mazzacco, Vice President/Director, Eddy Visiting Nurse Association/St. Peter’s Health Partners (invited) An executive panel from agencies providing licensed home care services will outline their quality care innovation efforts and provide guidance, tools and tips for planning and implementing quality initiatives. Attendees will have an opportunity for question and answers with panelists.

11:00am – Noon Common Areas of Quality Risk

(and Remedy) Identified in Surveillance Rebecca Fuller Gray, Director, Division of Home and Community Based Services, NYS Department of Health (Invited) This session will provide invaluable insights from the state surveillance of home care agencies and proactive opportunity for quality promotion/risk mitigation from the State’s Director for home care services. In this presentation, Ms. Fuller-Gray will examine areas of quality risk and/or deficiency identified in DOH surveys and present recommendations for remedy, and most importantly, prevention/mitigation of these risk areas and overall quality promotion.

Noon

Wrap Up and Adjourn

HCA Member Rate

$ 89 □

Non-Member Rate

$159 □ TOTAL: $___________

PAYMENT Please check method of payment: (Checks must be received by date of program).

____MC ____VISA ____ AM EXP

____ Check*

*Make checks payable to : HCA Education and Research and mail to: 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

Cancellations received in writing via email to info@hcanys.org by November 2, are refundable less a 25% administrative fee. No refunds after this date or for no shows. Substitutions are permitted.

Please fax to: (518) 426-8788