June 18, 2018 Edition of The Situation Report

AHHA

MLTC UPDATES

EMERGENCY PREP

SDH INITIATIVE

Following a recent DOH proposed rule, SED releases companion set of guidelines on prerequisites for training and oversight of advanced home health aides.

DOH meeting for MLTCs, Associations outlines enrollment figures, Community First Choice, LHCSA Contracting, Value Based Payments and more.

HCA participates in DOH committee to plan emergency preparedness drills targeted for two periods: Oct. to Dec. 2018 and March to May 2019.

6/29 is the new deadline to submit social determinants of health innovation proposals that can raise awareness of your efforts among payors, partners.

PAGE 5

PAGE 8

PAGE 10

PAGE 15

COMING UP The Opioid Crisis: Family and Caregiver Assessment Factors June 27, 2018 11:30 a.m. to 1 p.m. (Webinar) Blueprint for OASIS Accuracy: OASIS D 2-Day Workshop October 22 & 23: Workshop October 24: COS-C Exam NYC Registration for these and other HCA programs are on our Education and Events page at: https://hcanys.org/eventseducation/ upcoming-events

Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 26 | June 18, 2018

HCA President Seeks Medicare Payment Reform Fixes, Safeguards and Other Priorities in D.C. Visits with Congress, Federal Partners HCA President Joanne Cunningham is headed to Washington, D.C. this week for a span of meetings with the New York Congressional Delegation as well as strategy sessions with federal partners.

Ms. Cunningham will first meet with National Association for Home Care and Hospice (NAHC) President Bill Dombi, continuing our close coordination efforts with NAHC on federal advocacy efforts and messaging. She will also meet with the offices of New York’s Congressional Delegation – both with key office staff and lawmakers – to outline home care and hospice legislative priorities.

See FIXES p. 4

Legislative Funnel Extra Narrow for 2018 Session Finale The State Legislature today rolls into the final scheduled days of its 2018 session with a billowing number bills of bills, including pro-home care measures drafted and/or supported by HCA, facing an extra narrow funnel. Many bills, though necessary and ordinarily welcomed for passage, will be halted in this year’s substantially limited window for final bill movement.

See FUNNEL p. 2

INSIDE HCA President Seeks Medicare Payment Reform Fixes in D.C..............................1 Legislative Funnel Extra Narrow for 2018 Session Finale.....................................1 A Message from HCA Sponsor RBC Limited..........................................................3 SED Releases Proposed Regs on Advanced Home Health Aides............................5 Member Hiring Announcements.......................................................................7 HCA Bolstering Home Care’s Role on Elder Abuse Awareness..............................8 DOH Monthly Meeting for MLTC/MCO – Many Processes in Motion......................8 New DOH Workgroup Explores Hospice Promotion............................................9 Emergency Preparedness Developments........................................................10

State Geriatric Mental Health Council Features HCA Collaboration..............12 Home Care Agencies Invited to Join “Sepsis Coordinators Network”.............13 Important Hospice Billing Changes Outlined in CMS Guidance......................14 Deadline Extended for Social Determinants of Health Initiative...................15 OIG Posts Updated Work Plan....................................................................15 Upcoming Deadlines.................................................................................16 Webinar Given on Voucher Demo for Persons with Dementia......................17 HCA Provides Memos on NGS Home Care and Hospice Updates.....................17 Resources...............................................................................................18

The Situation Report: the Home Care Association of New York State FUNNEL from p. 1 As the Situation Report has noted throughout the past several months, the normal procedural flow of the legislative process and consequent movement of bills through committees and toward passage has been narrowed to a trickle. This results from the combination of shifts in the majority/minority composition in the state Senate, and the overall election year dynamics related to the Gubernatorial, state legislative and other statewide official races.

The Senate process in particular has faced overwhelming requirements for moving bills post-budget because the relatively close margin of Republican and Democrat conference members has required broader negotiation and agreement procedures for virtually any bills presented for action. Under this new set of requirements, the time and volume of bills simply out-scales the available session days and legislative capacity to discern and decide on all of the legislation that will be let through.

Nevertheless, HCA will continue to press for action on the series of proposals we’ve submitted and which were enthusiastically introduced by our bill sponsors in the Senate and Assembly. HCA has provided extensive information on these bills via the Situation Report and the HCA Legislative Action Center where HCA members are strongly encouraged to continue sending messages to the bill sponsors with a quick push of the button at https://p2a.co/SFtj5oq.

Categorically this array of bills supports: workforce for home care, hospice and MLTC; MLTC nursing home benefit coverage; and home care public health and mental health initiatives.

Below is a brief update on one of these bills – HCA’s home caremental health collaboration bill – which advanced this past week and is primed for a final floor vote, along with a description of some additional bills otherwise introduced for home care, hospice and health care broadly that have passed both houses. 

HCA Legislation to promote Home Care-Mental Health Provider Collaboration (S.8632 by Senator Robert Ortt and A.10938 by Assemblywoman Aileen Gunther) has been advanced to the Senate and Assembly Floor Calendars, positioned for vote and passage. HCA is urging passage prior to the session’s conclusion.

Continued on next page

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

2

Volume 3, No. 28 June 18, 2018 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole V ice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@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 & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Continued from previous page 

Legislation to permit Nurse Practitioner authorization under the Health Care Proxy law (S.7713-B by Senator Kemp Hannon and A.10345-A by Assemblyman Richard Gottfried) has passed the Senate and Assembly. The legislation authorizes nurse practitioners to witness a health care proxy, act as a health care agent and determine competency of the principal of such a proxy. The bill awaits delivery by the Senate to the Governor for signature, upon the Governor’s call to submit the bill.



The Physical Therapy Assistant Extender bill (S.8217 by Senator Kenneth LaValle and A.10381-A by Assemblyman Victor Pichardo) has passed both the Senate and Assembly.

This legislation, supported by HCA, will, if signed into law, extend through June 30, 2022 the authorization of physical therapy assistants (PTAs) to provide services in home care settings. Originally enacted in 1993, the provision has been extended numerous times. The bill awaits delivery by the Senate to the Governor for signature, ostensibly in time for the expiration of the extender on June 30.

We will have a full status report, along with special alerts as necessary, on these or other bills affecting home care, hospice and managed care that may be further considered in these final days.

3

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

 FIXES from p. 1 Protecting Medicaid remains a priority, and HCA will continue to educate the Congressional Delegation on the consequences of any payment changes affecting state Medicaid programs – as Congress has repeatedly contemplated – and the meaning of these changes for beneficiaries in New York.

More immediately, discussion will also center on vitally needed corrections and safeguards to the home health provisions of the Bipartisan Budget Act that was finalized in February.

As extensively reported to HCA members, this sprawling Congressional budget measure instituted major home health payment changes set to go into effect in 2020, including the move toward a 30-day unit of service which is at odds with the 60-day episodic payment system that currently exists.

HCA is seeking technical corrections that would mitigate the financial and service impact of this change for providers and beneficiaries. We also urge a piloting mechanism so that the payment reforms are tested first on a demonstration basis. These and other recommendations are included in a new HCA piece being shared with Congressional offices, titled Vital Corrections, Safeguards Needed in 2018 Home Health Payment Reform Act (see https://hca-nys.org/wp-content/uploads/2018/06/Vital-CorrectionsSafeguards-Needed-in-2018-Home-Health-Payment-Reform-Act.pdf).

With the reemergence of a new pre-claim review demonstration (see the June 4 edition of The Situation Report), HCA is urging Congressional oversight to make sure that the U.S. Centers for Medicare and Medicaid Services (CMS) doesn’t repeat the problems that caused CMS to halt a prior version of the demo in the first place. (CMS suspended pre-claim review in March of last year.)

The demo is not proposed for New York State, but CMS has signaled it is retaining the option to extend the demo to other states beyond those currently proposed. For background, see our new piece entitled CMS Restarts Pre-Claim Review Demo without Addressing Problems That Halted It (see https://hcanys.org/wp-content/uploads/2018/06/CMS-Restarts-Pre-Claim-Review-Demo-Without-AddressingProblems-that-Halted-It.pdf).

HCA is also reasserting our call for passage of the “Home Health Planning Improvement Act” (H.R.1825/ S.445) which is sponsored by New York Congressman Chris Collins, and also cosponsored by 12 of his New York Delegation colleagues as well as 177 Members of the House and 43 Senators. The bill would allow advanced-practice clinicians – not just physicians – to order and certify Medicare home health services.

Earlier this year, HCA engaged six of our CHHA members in Western New York – who collectively serve 35,000 Medicare beneficiaries in Rep. Collins’ district – to write Rep. Collins urging his work to bring this measure to the floor for a vote. HCA is sharing this joint provider letter and a related new advocacy document (see https://hca-nys.org/wp-content/uploads/2018/06/Pass-Home-Health-PlanningImprovement-Act.pdf) with the entire Delegation to push hard on this commonsense bipartisan solution, as we continue to engage with Rep. Collins and the whole New York Delegation on this issue.

Please stay tuned for further information on the federal advocacy front, including ways you can help support HCA’s platform on these critical issue areas.

4

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

SED Releases Proposed Regs on Advanced Home Health Aides At the June 11 Board of Regents meeting, the State Education Department (SED) presented proposed regulations to implement the Advanced Home Health Aide (AHHA) legislation passed and signed in 2016.

The regulations, which the Regents subsequently approved for adoption as an emergency rule, are at http:// www.regents.nysed.gov/common/regents/files/618ppca2.pdf.

According to the regulation summary, the emergency rule will become effective on June 12, 2018 and expires on September 10, 2018. It is anticipated that an additional emergency action will be presented for adoption at the July 2018 Regents meeting to keep the rule continuously in effect until it can be adopted as a permanent rule at the September meeting, effective October 3, 2018.

A Notice of Emergency Action and Proposed Rulemaking will be published in the State Register on June 27, 2018.

SED adds a new section 64.9 that: 

Defines AHHA, advanced tasks, direct supervision, home health services entity, routine medications, and other terms;



Establishes the criteria that RNs must comply with when assigning an AHHA to perform one or more advanced tasks, and for when RNs are supervising AHHAs to perform advanced tasks;



Establishes the criteria that a home health aide must meet to qualify for certification as an AHHA; and



Establishes criteria for AHHA training programs, as well as AHHA training and competency requirements.

A lot of the regulations are similar to what was advanced by the state Department of Health (DOH) in its proposed regulations issued on May 30 (see the June 4 edition of The Situation Report). Some additional information from SED’s regulations is as follows:

5



The AHHA training program curriculum shall include at least eighty hours of didactic classroom and skills laboratory training and at least forty-five hours of supervised practical training, which shall not be offered until at least three hours of didactic classroom training have been provided.



The AHHA training program curriculum shall address at least the following topics: 1) the assignment of advanced tasks; 2) working with supervising RNs; 3) infection control, injections and injection safety; 4) documentation relating to advanced tasks; 5) medication administration; 6) client communication; and 7) preparation for taking a department-approved competency examination.



Supervised practical training shall be provided in a home care setting in which the student performs advanced tasks for a client while under the personal supervision of an RN with a minimum of two years of nursing experience (at least one year of which must be in home health care).



Before being offered admission into an AHHA training program, the program sponsor shall, at a minimum, verify that each candidate: 1) has earned a high school diploma or a high school equivalency diploma; 2) is currently listed in the home care worker registry as having satisfied all applicable

The Situation Report: the Home Care Association of New York State requirements for certification as a home health aide; and 3) has completed at least one year of experience “providing home health or personal care services, or a combination of the same, as a certified home health aide or while working for a health services entity.” (HCA will be seeking clarification on the precise meaning of this last criterion, presented in quotation marks from the original text.) 



The AHHA and RN are required to work for the same hospice, home care services agency or enhanced assisted living residence.



The RN shall not assign an advanced task to an AHHA unless: 1) the client’s health status is stable; 2) the advanced task to be assigned is consistent with a physician’s, nurse practitioner’s or prescriber’s ordered or prescribed care; 3) the client or authorized individual has consented to the assignment of advanced tasks to the AHHA; 4) the health services entity has written policies and procedures in effect covering the assignment and performance of advanced tasks in accordance with applicable law; 5) the AHHA has demonstrated to the satisfaction of the supervising RN that he or she can competently perform the advanced task to be assigned; 6) the AHHA has agreed to perform the advanced task, including, but not limited to, documenting the performance of the task; and 7) the AHHA is able to communicate effectively with the client and understands the client’s needs.



6

As a requirement for successful completion of an AHHA training program, the program sponsor shall ensure that each student has successfully completed a competency evaluation, as determined by an RN, after the nurse has personally observed the student perform certain tasks outlined in the second bullet on the bottom half of p. 5. The other topics may be evaluated through written examination, oral examination, or observation of an AHHA performing tasks.

An AHHA shall document the performance or nonperformance of each assigned advanced task in the client’s individualized service or care plan or health record.

Volume 3, No. 28 June 18, 2018 

HCA will be submitting comments on DOH’s and/or SED’s AHHA regulations. We recommend that members also do so and/or send us your feedback for inclusion in our comments. Given that the DOH and SED regulations are at different stages (one as an emergency rule, effectively on the books, and another as a proposed rule), HCA will find out what actions providers can take now – if at all – as information is still pending as to policies and procedures for AHHA training programs and other factors.

HCA was actively involved in numerous discussions in the lead-up to this legislation that established AHHAs after the measure underwent various iterations in the legislative process. HCA advocated for numerous provisions to support prospective AHHAs, participating nurses, agencies and managed long term care (MLTC) plans. We also sought: greater flexibility; reimbursement for MLTCs, agencies and aides; a stronger role for LHCSAs; and provisions facilitating alignment for MLTCs and provider agencies in AHHA authorization and use. These were not considered by lawmakers in the original passage of the law and will remain areas to address as the law is implemented.

HCA will be working closely with DOH, SED and all parties to optimize the potential assistance of AHHAs in the MLTC, home care and hospice delivery structure.

DOH Home and Community Based Services Director Rebecca Fuller Gray and Deputy Director Margaret Willard gave a presentation on AHHAs at our annual conference in May. We have also been requesting assistance for MLTCs and better synchronization of AHHA provisions for MLTCs and providers.

HCA looks forward to working further in supporting members to maximize the application of AHHA services for patients and all affected entities as this legislation becomes implemented.

Volume 3, No. 28 June 18, 2018

The Situation Report: the Home Care Association of New York State



HIRING BRANCH DIRECTOR: QUEENS LOCATION Able Health Care Services believes in quality care for our clients. Join us for an exciting career in Health Care. Currently, we are looking for a Branch Director to join our team. We offer competitive salary and benefits.

Position Summary 

Management and supervision of a team of professional, paraprofessional and clerical employees; accountable for providing competent care and achieving optimal patient/client outcomes for the Certified Agency.

As the nation’s largest not-for-profit home- and community-based health care organization, VNSNY is transforming to become a leading home- and community-based care management organization.

VNSNY is hiring for the Executive Vice President and Chief of Provider Services to move the organization forward on this continuum by providing strategic planning, leadership, and direction to all VNSNY Provider Services operations and our population health and clinical support services; business development; and clinical education departments.

Responsibilities



Supervises Inquiry/Intake referrals for home care services to individual patients/ clients and their families.



Oversees strategies for Provider Services programs consistent with established VNSNY financial targets and corporate objectives.



Provides nursing education and training as deemed necessary to increase the value of patient care as well as enhance the agency’s ability to offer new clinical initiatives.



Plans, directs, and coordinates the efforts of corporate sales and marketing functions to achieve VNSNY short- and long-term strategic goals.



Monitors and evaluates issues, trends, and needs for Provider Services programs; formulates strategies to address trends/needs.

The candidate for this position must be a NYS licensed Registered Nurse, bachelor’s prepared with:



A minimum of 5 years work experience in Licensed and Certified Home Care agencies.



Strong Knowledge of Medicare/Medicaid/ MLTC and managed care regulations.



Excellent communication, human relations and organizational skills are needed.



Self-motivator, assertiveness and independent decision-making skills are essential.

Please e-mail inquiries to Sandra Weintraub at SandraW@ablehealthcare.com.

Able Health Care Services, Inc. is an Equal Opportunity Employer

7

Executive Vice President and Chief of Provider Services, VNSNY

Required Experience



10+ years of progressively responsible leadership or program implementation experience in complex, integrated health care, hospital, and/or home health provider organization.



Excellent financial and operational track record; proven ability to manage a challenging and constantly changing health care delivery system in a competitive environment and within the context of health care reform.



Master’s Degree in a health care-related field.

Interested candidates should e-mail their CV to: Andrew Wise, Vice President, Talent Management and Organizational Development, at Andrew.Wise@vnsny.org.

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

HCA Bolstering Home Care’s Role on Elder Abuse Awareness June 15 marked World Elder Abuse Awareness Day – a day that for the past decade and a half has been set aside by the International Network for the Prevention of Elder Abuse and the World Health Organization “to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons by raising awareness.”

The safe, dignified and quality care and life of elders is fundamental to home care and home care’s intrinsic mission. It is a “charge” to our field and to our caregivers, shaped by our core societal values. It is also a public health imperative to improve outcomes, like hospital use and emergency room aversion, morbidity prevention and averting catastrophic costs.

HCA marked this day with a highly energized meeting of the HCA Quality Committee, which formulated a series of new HCA initiatives we will now be planning, including efforts for proactive identification of risks, signs and interventions related to elder neglect, abuse and maltreatment. HCA was privileged to have top policymakers and experts joining to lead this discussion, including senior officials at the New York State Office for Aging, physician experts in elder care and emergency medicine, and other community based specialists in elder abuse prevention and care.

HCA will be providing further details to the membership about these creative proposals, and we urge awareness among all home care agencies and clinical partners in their daily efforts to ensure the quality care and security of older New Yorkers.

For further information, please contact Al Cardillo (acardillo@hcanys.org) or Celisia Street (cstreet@hcanys.org).

DOH Monthly Meeting for MLTC/MCO – Many Processes in Motion The state Department of Health (DOH) on June 14 held its monthly meeting for mainstream managed care organizations, managed long term care plans, and the state associations with health plan members.

Slides for the meeting are at https://hca-nys.org/wp-content/uploads/2018/06/MCO-Policy-Mtg-6-14-2018.pdf.

Among the areas covered were:

8



Enrollment updates, including the continued increases in MLTC enrollment, and decreasing trends in Fully Integrated Duals Advantage (FIDA).



Value Based Payment phase 2 status summary. This material was largely reviewed recently in various HCA and DOH communications; DOH indicated that it will soon be seeking to finalize its proposed phase 2 upside/downside plan, characterized the comments thus far as generally positive, and urged any final comments quickly.



Fiscal Intermediary Advertising. DOH indicates that further guidance is being developed.



Congestion Pricing Survey. DOH reviewed the health plan survey it requested to attempt to capture the impact of congestion pricing in New York City. A version of congestion pricing was included in the state budget and adds certain surcharges applicable to for-hire vehicles in Manhattan south of 96th Street,

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

though a much broader plan was sought and is still being advocated for. Surveys were due on June 13 and DOH urged any outstanding surveys to be delivered as soon as possible; further information to come. 

Community First Choice and Assisted Living Implementation. DOH reviewed the status of each, raising discussion on issues and implications by DOH and meeting participants, as well as potential date delays; DOH will be considering the various factors and further information/guidance will ensue.



LHCSA Contract Limits and Nursing Home Benefit Change. DOH reiterated the budget provisions and indicated more guidance would be coming; meeting participants emphasized the extensive operational implications of these changes, and urged DOH to work closely with the industry representatives to carefully assess and address these.



Requirement for Medicaid Enrollment. DOH provided a status update on provider activity and challenges to meet the new requirement for Medicaid enrollment. Providers who historically have not been “direct billers” to Medicaid may not have been previously enrolled, and now must enroll. Much guidance has been required, and DOH has posted in the slide deck (see link on p. 8) a series of resource links to assist. DOH indicated that in the coming months it will be “engaging health plans to establish procedures to allow them to be able to rely on NYS Medicaid initial and monthly federally mandated sanction database checks when providers are enrolled in Medicaid” in order to help administratively ease the burden on plans to check enrollment status under the new requirement. HCA has written extensively about this requirement and alerted providers about the importance of enrolling in order to prevent any risk of exclusion from Managed Long Term Care.

These significant items are all “in motion” in terms of state implementation, with the Department indicating that further guidance will be forthcoming. HCA will seek to provide input in all possible areas to help inform and make the guidance as supportive as possible, particularly given the major implications of these changes on top of existing pressing areas for plans and providers.

New DOH Workgroup Explores Hospice Promotion The state Department of Health has convened a new workgroup to explore hospice access and participation, including barriers, challenges and opportunities for improvement.

The first meeting of this workgroup, which includes HCA, provided a round-robin exchange by the participants on pertinent hospice background, hospice utilization, information/referral challenges, including educational and motivational barriers, eligibility and fiscal factors, collaboration barriers among service providers, and other issues.

HCA highlighted areas of law, program and policy which offer points of resource or areas for problem-solving.

HCA also referred the group to the recent milestone report of the State Palliative Care Education and Training Council and its recommendations for improved access through education, training and practice initiatives in palliative care. (See the May 14 edition of The Situation Report.) The recommendations particularly focus on nurses and social workers who are often the key clinicians in care delivery and planning for patients facing life-limiting illness, and the conduits between patients/families and physicians in relation to needs, status changes and advance care planning.

Continued on next page

9

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Continued from previous page This meeting comes on the heels of a major May 23 meeting held by the HCA Hospice and Palliative Care Forum diving deeply into the recent State Council recommendations and additional areas of hospice support and development. HCA and the Forum outlined a broad follow-up to this meeting. More details to come.

HCA looks forward to shaping much needed policy and program support for hospice and palliative care, through our Forum, this new workgroup and other venues. HCA has a series of bills currently introduced in the State Legislature that would support hospice. HCA is also an active member of a workgroup on advanced care planning and support for Medical Orders for Life Sustaining Treatment (MOLST).

HCA will keep members informed on the progress of these initiatives, and member input is strongly encouraged and welcome!

For further information on these developments or on HCA’s work in hospice and palliative care, or to become more involved in our efforts, please contact Al Cardillo (acardillo@hcanys.org), Patrick Conole (pconole@hcanys.org) or Celisia Street (cstreet@hcanys.org).

Emergency Preparedness Developments New exercise/drill design project for 2018 The state Department of Health (DOH) convened its emergency preparedness exercises and drills committee, including HCA (a committee member), to assist in design and development activities for fall 2018 to spring 2019.

Among DOH’s priority areas for these exercises are: health care facility evacuation, medical surge, continuation of operation plans, medical countermeasure distribution and dispensing, and infectious disease.

Exercises will include virtually all health system partners, emphasizing not only each sector’s individual role, but the collaborative roles and communications required for the system to be effective in emergency response.

Building on this past year’s experiences, one of the drills will focus on interoperable communications. In this initial planning for this drill, HCA recommended that the lessons learned from this last round, as discussed in an April “after-action” panel with state officials and all sectors, be considered and incorporated into the design and execution of these upcoming exercises.

Commenting on the facility surge and evacuation priorities discussed in this week’s meeting, HCA underscored the critical importance of support for sustained in-home management of patients (particularly “priority level 1” patients) during emergencies, and in the ability to quickly and effectively receive facility discharges and initiate and sustain care at home. HCA emphasized this pivotal role of home care in the overall emergency response structure.

Targeted periods for the planned exercise and drills are sometime during the October 1 to December 2018 period, and the March to May 2019 period.

Planners are still settling on whether to conduct the drills statewide, or by region, and if by region whether to conduct all on the same day or stagger them.

Continued on next page

10

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Continued from previous page The committee will work during the summer and convene in August to further map out plans for these exercises.

State and federal regulations require provider participation in exercises and drills. Providers can fulfill these requirements by participating in the state-sponsored exercises that assist in readying for emergency response.

Additional State and Regional Developments HCA met with emergency preparedness collaborating partners at DOH and the New York State Association of Health Care Providers (HCP) to discuss progress and plans on statewide emergency preparedness initiatives in home care and hospice.

These include a continuation of local networking sessions for providers and local preparedness partners, which we have been conducting across the state over the past two years; compliance with new federal and state requirements; finalizing a toolkit to assist agencies with patient and family emergency preparedness (discussed further below), and an upcoming multi-sector planning session in July.

HCA will be reporting in detail on all of these initiatives in subsequent editions of the Situation Report, and in HCA alerts, educational sessions and our other communications.

Also, in the past several weeks, with more sessions to come, the regional Health Emergency Preparedness Coalitions (HEPCs) have been conducting meetings to discuss developments and promote engagement and collaboration on critical emergency preparedness items.

This past week, HCA and several home care providers participated in the Central New York HEPC meeting, where the topics discussed included: a Point of Dispensing (POD) exercise held to simulate vaccination distributions during a Hepatitis A exposure; an After Action Report on the POD; a data base of Medicare beneficiaries who have power-dependent devices; a social vulnerability index that tracks individuals whose social conditions (housing, transportation, etc.) affect emergency preparedness activities; and the Access and Functional Needs Committee’s work on emergency preparedness planning for residents at home.

At this meeting, HCA emphasized the readiness of home care and hospice providers to participate in the POD, Coalition Surge Test and other exercises, and the necessity of involving them in all emergency preparedness activities.

On the issue of consumer-oriented in-home planning, HCA (in conjunction with a provider workgroup), HCP and DOH have compiled and will soon be making available a toolkit for home care and hospices statewide to assist with patient and family emergency preparedness. Official release of this toolkit is expected within the next several weeks.

HCA strongly encourages all community based providers and health plans to be involved with your regional HEPC as it offers a tremendous opportunity to increase and support your emergency preparedness work and meet the state and federal requirements that you participate in exercises and fulfill other responsibilities. A calendar of upcoming HEPC meetings is at https://www.urmc.rochester.edu/emergency-preparedness/ calendar.aspx.

For further HEPC information and emergency preparedness guidance, contact at HCA Andrew Koski (akoski@hcanys.org) or Al Cardillo (acardillo@hcanys.org).

11

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

State Geriatric Mental Health Council Features HCA Collaboration The New York State Geriatric Mental Health Council received a presentation this week from HCA Executive Vice President Al Cardillo on the significance and opportunities for promoting mental health-home health collaborative care.

Mr. Cardillo and representatives of the state Office of Mental Health (OMH) reviewed for the Council the policy, program and clinical logic of mental health and home care working together to support patients in the community. We also described the state and field-level work being done over the past year by OMH and HCA, in combination with our local home care and mental health providers, to advance this collaboration.

HCA and OMH further mapped out plans and opportunities to drive this forward.

Among the next steps are: 

Securing the passage of HCA-authored legislation to include home care and mental health provider collaboration under the provisions of the state Geriatric Mental Health Demonstration funded each year in the state budget (see p. 2);



Exploring home care-mental health provider partnerships under the “Provider Collaboration Dear Administrator Letter (DAL)” issued by DOH and developed with HCA. That DAL, extensively reported to the membership, supports a structure of collaboration opportunities for home care, physician practices, hospitals and other providers in maintaining Article 36 jurisdictional boundaries for utilization of appropriately licensed and certified entities in the delivery of home care.



Joint HCA, OMH and Association for Community Living educational conferencing and related steps to bring home care and mental health, particularly community housing, together in service and care management for individuals;



Relief of regulatory, procedural and reimbursement barriers; and



Training opportunities in key mental health areas for home health practitioners and aides which we are encouraging as part of the Workforce Investment Organization (WIO) initiative.

HCA legislation sponsored by Senate Mental Health Chair Robert Ortt (S.8632) and A.10938, sponsored by Assembly Mental Health Chair Aileen Gunther, is currently advanced to the floor calendar in each chamber and positioned for passage.

HCA appreciates the opportunity to address the Council and the exemplary partnership with and support from OMH. HCA looks forward to the opportunities this effort will bring to the home care and mental health patient, family and provider communities.

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

12

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Home Care Agencies Invited to Join National “Sepsis Coordinators Network” Home care agencies have an invaluable opportunity to take further steps in the effort to stop sepsis, and are invited to participate in a new national Sepsis Coordinators Network.

The national Sepsis Alliance patient advocacy non-profit organization has launched a Sepsis Coordinator Network – a first of its kind online network that provides health care professionals with evidence-based best-practice resources and guidance to improve outcomes for patients with sepsis.

As reported in last week’s newsletter, HCA Executive Vice President Al Cardillo received a Quality Award from IPRO, the state’s Quality Improvement Organization and a partner on HCA’s Stop Sepsis at Home initiative. The award is for “Ongoing Commitment to Educating Home Health Professionals and the Public About Sepsis.” Above, Mr. Cardillo receives the award from IPRO CEO Theodore Will, MPA, FACHE (left) and Dennis Wagner, MPA, director of the U.S. Centers for Medicare and Medicaid Services Quality Improvement and Innovation Group.

In announcing the initiative, Sepsis Alliance Executive Director Tom Heymann stated that “the Sepsis Coordinator Network is a response to the varying quality of sepsis treatment across the United States by providing a central hub for health care professionals to access sepsis best-practice resources and communicate with experts in the field.”

The Sepsis Coordinator Network is open to all health care professionals with an interest in improving sepsis care and there is no fee to become a member. For more information, and to register, visit www.SepsisCoordinatorNetwork.org.

Sepsis Alliance has been a core partner and invaluable supporter of HCA’s “Stop Sepsis At Home” initiative.

The Alliance’s chief medical officer was an expert advisor in the creation of HCA’s home care sepsis tool and intervention initiative. Alliance materials and video training have been a major contributor to HCA’s training and education sessions around the state, and the Alliance has participated in-person in several of these sessions, as well as served on HCA’s Sepsis Steering Committee. This past week, Sepsis Alliance was recognized with the “2018 Global Sepsis Award,” for which we extend our congratulations.

Home care providers who have been trained and authorized for use of the HCA sepsis tool now blanket New York State, and providers and entire state associations in other states are engaged with HCA for implementation of this tool in their health systems. Home care agencies, managed long term care plans or other home and community based organizations wishing to integrate this new, first-in-the-nation sepsis tool into their patient care practices should contact HCA at sepsistool@hcanys.org. Further information is on our campaign website at http://stopsepsisathomeny.org/.

13

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Important Current and Future Hospice Billing Changes Outlined in CMS Guidance In 2017 the U.S. Centers for Medicare and Medicaid Services (CMS) announced significant changes that, beginning in early 2018, would allow hospice providers to electronically submit Notices of Election (NOE) and related transactions and to correct election or revocation dates without needing to cancel all transactions related to the hospice election.

Most recently, CMS issued a Medicare Learning Network (MLN) Matters Article SE 18007 (https:// www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/ SE18007.pdf) that reminds hospice billing staff about these options, but also announces forthcoming changes to the way hospice benefit periods are configured in the Common Working File (CWF) in order to: 

Reduce NOE timely filing exception requests for providers, by ensuring benefit periods can be cancelled without removing the NOE receipt date.



Allow Notices of Termination/Revocation (NOTRs) to be submitted at any time, rather than only when a benefit period covering the revocation date has been created by claims.



Reduce workload for providers when reprocessing periods by automatically removing benefit periods when all claims in the period are cancelled.



Enable easier implementation of future policy changes by ensuring data in Medicare systems reflect hospice coverage requirements more clearly.

MLN SE 18007 contains very complicated billing information, so hospices are urged to ensure that their billing and claims processing staff are made aware of these changes. Additionally, the article contains some very helpful tables and screen “shots,” so review of the direct source materials is strongly recommended.

Hospice providers have been slow to transition to electronic submission of NOEs because of systems processing and time frames needed by software vendors to program the changes to their billing software.

MLN SE 18007 also announces improvements to the way in which hospice elections are displayed in the claims processing systems. This redesign will ensure that hospice election and revocation date information are separate from benefit period information, so that the two types of information can be changed independently. Effective July 2, 2018, a new hospice election period will be added to the CWF system to carry hospice election-related information. The existing hospice benefit period screens will continue to look the same, but election-related fields on those screens (revocation indicators, NOE receipt dates) will no longer be used.

The Medicare Administrative Contractors (MACs) will convert all existing hospice benefit periods into the new election period and benefit period format if the revocation date on the benefit period is blank (which would signify a current election) or is four years old or less. Older benefit periods will remain in the Medicare systems unchanged. All new hospice elections received on or after July 2, 2018 will create periods in the new formats.

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

14

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Deadline Extended for Social Determinants of Health Initiative The state Department of Health (DOH) has extended the deadline from June 15 to June 29 to submit a proposal under its “Call for Social Determinants of Health (SDH)” initiative.

The Call for SDH application is at https://www.surveymonkey.com/r/SDH_innovations.

This is a new initiative to identify innovative ideas to effectively address SDH for Medicaid members across New York State. The intent is to solicit input from interested parties across the state and around the country.

Innovations will be reviewed by a team of health care experts identified by DOH. Top innovations will receive special recognition but all innovations, with the consent of the submitting organization, will be shared publicly by DOH. Later this fall, DOH will host a Social Determinants of Health Innovation Summit that will allow the applicants with the best solutions to pitch their product or idea to a panel of expert judges and audience members. At the summit, winners of each category will be honored with a “2018 SDH Health Innovation Award.”

While there is no funding from the state available for this initiative, it is a chance for innovative companies and organizations to receive exposure to key health care decision makers including, but not limited to, health care providers, Managed Care Organizations, and Performing Provider Systems under the Delivery Reform Incentive Payment (DSRIP) program.

Questions can be sent to SDH@health.ny.gov.

OIG Posts Updated Work Plan The federal Office of Inspector General (OIG) has posted its updated Work Plan.

It is at https://oig.hhs.gov/reports-and-publications/workplan/index.asp.

Some items of interest include:

15



Review of Home Health Claims for Services With 5 to 10 Skilled Visits: OIG will review supporting documentation to determine whether home health claims with 5 to 10 skilled visits in a payment episode in which the beneficiary was discharged home met the conditions for coverage and were adequately supported as required by federal guidance.



Inappropriate Denial of Services and Payment in Medicare Advantage: OIG will conduct medical record reviews to determine the extent to which beneficiaries and providers were denied preauthorization or payment for medically necessary services covered by Medicare and will determine the reasons for any inappropriate denials and the types of services involved.

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Upcoming Deadlines

Requirement/Change

Effective/Due Date More Information

Home Care, Fiscal Intermediaries and other providers who contract with Managed Care Organizations must be enrolled in Medicaid

Still being accepted, but providers are advised to submit now

https://www.emedny.org/info/ProviderEnrollment/ManagedCa reNetwork/index.aspx

Transition Period for Using Health Insurance Claim Number (HICN) or April 1, 2018 to https://www.cms.gov/Medicare/NewͲMedicareͲ new Medicare Beneficiary December 31, 2019 Card/index.html Identifier (MBI)

16

Long Term Care Planning Council Survey

Due June 18, 2018

https://www.surveymonkey.com/r/HM9DM97

Health Workforce Retraining Program RFA

Due June 22, 2018

https://www.health.ny.gov/funding/rfa/17842/index.htm

Rural Health Network Development Program RFA

Due June 28, 2018

https://hcaͲnys.org/wpͲcontent/uploads/2018/05/RuralͲ HealthͲNetworkͲDevelopmentͲProgramͲ_RFP_MayͲ2018.pdf

Call for Social Determinants of Health Innovations

Application due June 29

https://www.surveymonkey.com/r/SDH_Innovations

Managed care organizations will initiate termination of contracted providers who have not enrolled in Medicaid

July 1, 2018

https://www.emedny.org/info/ProviderEnrollment/ManagedCa reNetwork/index.aspx

OSHA 2017 Form 300A form (A Summary of WorkͲRelated Injuries Due July 1, 2018 and Illnesses)

https://www.osha.gov/injuryreporting/index.html.

Hearing on state Department of Labor’s proposed rule to exclude meals and sleep time for all employees

July 11, 2018

www.labor.ny.gov

Certified Home Health Agency 2017 Medicaid Cost Report

Due July 16, 2018 (extensions may be granted, as per https://commerce.health.state.ny.us/public/hcs_login.html HCA’s request to DOH; contact HCA for details)

Personal Care Provider 2017 Medicaid Cost Report

Due: July 30, 2018

https://commerce.health.state.ny.us/public/hcs_login.html

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Webinar Given on Voucher Demo for Persons with Dementia Last week, the state Department of Health (DOH) gave a webinar on a new voucher demonstration program to subsidize the cost of assisted living for individuals with Alzheimer’s disease and/or dementia that was part of the final state budget.

The webinar handout and other materials are at https://health.ny.gov/facilities/adult_care/voucher/ index.htm.

In this demonstration program, DOH may subsidize up to 75 percent of the average private pay rate in the region for the monthly cost of a Special Needs Assisted Living Residence (SNALR) for an approved applicant living with a diagnosis of Alzheimer’s disease and/or dementia who is, to the best knowledge available, unable to privately pay and would otherwise be discharged to a skilled nursing facility.

This program authorizes 200 vouchers to be issued through an application process to those applicants who demonstrate financial need and meet the necessary level of care and retention standards for a SNALR. Each approved voucher is for 12 months, with the ability to renew.

The amount of the voucher will depend on the applicant’s ability to contribute to their monthly service fee.

The law authorizes voucher amounts of up to 75 percent of the regional monthly cost of a SNALR. Facilities licensed as a SNALR have the option of participating in the Demonstration and DOH will set a cap on the number of voucher residents each facility will be required to accommodate. The cap will be set once the Department knows the total number of facilities that have agreed to participate in the program.

HCA Provides Memos on NGS Home Care and Hospice Updates New York’s Medicare Administrative Contractor, National Government Services (NGS), held two advisory meetings last week with updates to the home care and hospice provider communities. HCA Vice President Patrick Conole participated in both of these meetings, collecting information and providing feedback to NGS. Memos summarizing both meetings are posted at the links below.

Home health memo: https://hca-nys.org/wp-content/uploads/2018/06/061518NGSHomeHealthMemo.pdf Hospice memo: https://hca-nys.org/wp-content/uploads/2018/06/061518NGSHospiceMemo.pdf The memos provide information on Medicare payment and regulatory issues. The home care memo has some specific insights about the new “Targeted Probe and Educate” audit process as well as Comprehensive Error Rate Testing (CERT) data findings that will assist providers in responding to these reviews and ensuring compliance. The hospice memo similarly provides audit and reimbursement updates, medical review and appeals data and more.

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

17

The Situation Report: the Home Care Association of New York State

Volume 3, No. 28 June 18, 2018 

Resources 

“Housing And Health: An Overview Of The Literature,” Health Affairs https://www.healthaffairs.org/do/10.1377/hpb20180313.396577/full/HPB_2018_RWJF_01_W.pdf



“Overcoming Challenges To Medicaid Investments In Social Determinants Of Health,” Health Affairs https://tinyurl.com/ycgogmm3

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

18

Webinars for Home Health and Hospice Aides 2018 - 2019

E NJOY

THE B ENEFITS OF W E B I N A R B A S E D E D U C AT I O N

• Convenient

• Cost-Effective • No travel expenses or time • No limit to the number of participants from your agency through your registered site connection.

www.hca-nys.org

July 12, 2018: The Aide’s Role in Understanding Hospice and End of Life Care (registration deadline is July 6) Speaker: Cindy Morgan, RN, MSN, CHC, CHPN What does End-of-Life and Hospice care really mean? This presentation will clarify the meaning of hospice and EOL care.

Some of the misconceptions about hospice and EOL care will be discussed and explained. Participants will have a better understanding of helping patients live until they die and strategies that will promote quality of life at the end of life for patients and families.

August 9, 2018: The Aide’s Role in Caring for Older Adults in Home Care (registration deadline is August 3) Speaker: Kathie Smith, RN, BSN According to Healthy People 2020 from the Office of Disease Prevention and Health Promotion, as Americans live longer, growth in the number of older adults is unprecedented. In 2014, 46.3 million of the US population was aged 65 or older and is projected to reach 98 million by 2060. In 2012, 60% of older adults managed 2 or more chronic conditions. Many of the clients you provide care for in the home will be older adults with chronic conditions such as heart, lung, kidney disease, diabetes, cancer or other conditions. This presentation will focus on providing care for the older population.

September 13, 2018: The Aide’s Role in Quality Improvement in Home Care (registration deadline is September 7) Speaker: Jane Garrett, RN, BSN, MHSA What is QAPI? This session will describe the requirement for home health and hospice agencies to conduct Quality Assessment and Performance Improvement (QAPI) activities including a family satisfaction survey. How your agency performs on these measures is available to the public. In-home aides will learn how they play a role in supporting QAPI.

October 11, 2018: The Aide’s Role in HIPAA and Confidentiality (registration deadline is October 5) Speaker: Michelle White, DNP, RN, CNL This workshop will focus on assisting your In-Home Aides in understanding HIPAA and confidentiality guidelines.

This workshop will offer practical tips to ensure that the para-professional adheres to the required privacy standards. Also included: the impact of social media such as Facebook, My Space, YouTube and cell phones, text messages, etc.

November 8, 2018: The Aide’s Role in Managing Stress in the Workplace (registration deadline is November 2) Speaker: Kathie Smith, RN, BSN Stress is the body’s reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses. You can experience stress from your environment, your body, your thoughts. Even positive life changes such as a promotion, or the birth of a child produce stress. Taking care of yourself is an important part of your overall wellbeing and stress management is a component of that. This presentation will cover tips on managing stress.

December 13, 2018: The Aide’s Role in Post-Traumatic Stress Disorder (registration deadline is December 7) Speaker: Cindy Morgan, RN, MSN, CHC, CHPN An estimated 8% of Americans or 24.4 million people – have PTSD at any given time. Learn the risk factors related to PTSD, how to best work with your patients who have PTSD and strategies to help promote their best quality of life by attending this webinar.

All Live Webinars Are Held From 3:00 – 4:00 PM. A Recording of Each Webinar Will Be Accessible for 30 Days Following The Live Event.

January 10, 2019: The Aide’s Role in Ethical Issues Facing Nursing Assistants (registration deadline is January 4) Speaker: Jane Garrett, RN, BSN, MHSA In this webinar, commonly accepted principles of health care ethics will be discussed. This program will help the learner explore examples of difficult situations and how to put these principles into practice and make ethical decisions in the home health care environment.

February 14, 2019: The Aide’s Role in TBD (registration deadline is February 1) Speakers: John Conrad and Libby Hart, RN This session has not been finalized at this time.

March 14, 2019: The Aide’s Role in Infection Prevention and Control (registration deadline is March 1) Speaker: Michelle White, DNP, RN, CNL This workshop will focus on understanding the basic principles of infection prevention and control. This workshop will also focus on Blood Borne Pathogens and the principles surrounding transmission and methods in which the aide can protect themselves and the patient.

April 11, 2019: The Aide’s Role in Professionalism and Work Ethic in Home Care (registration deadline is April 5) Speaker: Kathie Smith, RN, BSN Providing care in a setting that enables one-to-one care offers opportunities for the client to be able to stay in their home and for the In-home aide to build strong relationships with the client and family. These relationships can feel rewarding to both the client and the In-home aide. While having that positive and caring relationship is important to the client’s care, it is also important to remember that as an employee of an agency and as a home care provider in the home, certain standards need to be upheld. These standards help you to maintain a professional relationship with the client and family. This presentation will cover professionalism for the In-home aide.

May 9, 2019: The Aide’s Role in Understanding Legal Issues for the Nurse Assistant (registration deadline is May 3) Speaker: Cindy Morgan, RN, MSN, CHC, CHPN No health care provider is immune from the potential for legal issues. When providing care for patients it must be done in a legal and ethical manner. This presentation will list ethical principles we should consider when delivering care as well as the more common allegations such as negligence, assault and battery and abuse that Nurse Aides should understand. Increased knowledge promotes adherence to standards of care and compliance with regulations and your agency’s policies and procedures.

June 13, 2019: The Aide’s Role in Understanding CVAs (registration deadline is June 7) Speaker: Jane Garrett, RN, BSN, MHSA In this webinar, it will be discussed how 80% of all strokes can be prevented with healthy behaviors, long term effects of a stroke may be minimized with immediate treatment and more people are surviving and beating stroke.

This webinar series is presented by the Association for Home & Hospice Care of North Carolina in partnership with HCA Education & Research, Inc. offering providers valuable information, tools and techniques to enhance practice skills. Please be aware that NYS laws and regulations may differ from that discussed in the webinar. All NYS providers must adhere to all relevant state and local laws.

2018-2019 Webinars for Home Health & Hospice Aide’s REGISTRATION FORM Agency Name: _____________________________________________________________________________________ Street Address: ____________________________________________________________________________________ City/State/Zip: _____________________________________________________________________________________ Contact Name and Title: _____________________________________________________________________________ Phone:_____________________________________________ Fax: _________________________________________

Email: ___________________________________________________________________________________________ (Required)

REGISTRATION FEE Check all that apply (Please note: all webinars take place from 3:00 pm – 4:00 pm) ____ July 12 ____ August 9

____ Sept. 13 ____ Oct. 11 ____ Nov. 8

_____ Dec. 13

____ Jan. 10 _____ Feb. 14

____ March 14 ____ April 11 _____ May 9

_____ June 13

HCA Member

$149 per program X _____ (# of programs) = $___________ TOTAL DUE

Non-Member

$199 per program X _____ (# of programs) = $___________ TOTAL DUE

Check here to register for the Full Series of 12 Webinars and save $240!!  HCA Member- $1,548  Non-Member- $2,148

There is no limit to the number of attendees from your agency who may participate through your single site connection.

Registration fees are based on each connection and may not be shared between agencies or sites within an agency. For multi-site participation, each location must be registered. Prior to each webinar, you will receive an e-mail containing your dial-in and log-in information, handouts, and a sign-in sheet for your site participants.

Recording of each webinar will be made available after the program, and will be accessible for 30 days following the live event.

Certificate of Completion: Following the webinar, a certificate of completion will be emailed to the primary registrant. The agency supervisor may sign a certificate for each HHA participating in the webinar for documentation of their training.

PAYMENT Check method of payment (If paying by check, check must be received 2 days prior to program date). ________MasterCard

________VISA

________ 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: ____________ ________________________________________________ ________________________________________________ Street Address (Billing for Card) City/State/Zip (Billing for Card)

________________________________________________ Name on Card ________________________________________________ Authorized Signature

Cancellation Policy: Fees will be refunded only if written cancellation is received by HCA at info@hcanys.org one week prior to the selected program(s). In the event you cancel, HCA will retain, or charge, $40 of the initial fee per registrant, to cover administrative processing.

No refunds after handouts are provided. Please contact info@hcanys.org if you need assistance, or call 518-426-8764.

Fax to (518) 426-8788