CAPITAL AWARDS ANNOUNCED
24 HOUR/LIVE-IN GUIDANCE
PFL REGULATIONS ADOPTED
NEW MEDICARE CARDS
DOH announces awards totaling over $491 million from the statewide Health Care Facility Transformation Program to help support goals of DSRIP.
Download guidance details released by DOH to address concerns raised by HCA and others based on recent court decisions.
The NYS Worker’s Compensation Board has issued final regulations to implement the state’s Paid Family Leave Program. Download the final regulations.
CMS will begin mailing new Medicare cards with a new Medicare number to patients in April 2018.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 28 | July 24, 2017
COMING UP Senior & Financial Manager’s Retreat September 7-8 Mohonk Mountain House New Paltz Optimizing Your Agency’s Revenue Cycle for Improved Financial Performance September 13, 2017 New York City All HCA programs and registrations are posted at http://hcanys.org/eventseducation/upcomingevents Summer Schedule HCA is publishing The Situation Report on a biweekly schedule for the summer. Our next edition will be on August 7. We will notify you by e-mail of all important breaking updates.
DOH Affirms F2F Plan New York State Department of Health (DOH) officials have affirmed the state’s plan for releasing home care agency and physician guidance on the implementation of the Faceto-Face (F2F) encounter requirements for Medicaid patients. DOH intends to publish F2F guidance in its July edition of Medicaid Update and to also circulate the guidance as an attachment to a DAL that is under development. DOH could not say exactly when these documents would be accessible. HCA, the State Medical Society and members of our joint physician-homecare task force had worked to develop and provide to DOH a draft document for use as a basis for the state’s F2F guidance. HCA appealed in June to DOH to post this or whatever it deemed its final guidance to the Health Commerce System so that it could be accessed timely given the July 1 F2F implementation date. Instead taking the Medicaid Update and DAL path described above, the guidance is still not accessible. The guidance provided by HCA and the Medical Society was drafted in straightforward, easy to follow language and exempted the wide array of New York models that fall under “managed care” (the federal Medicare procedures for F2F exempt managed care). Moreover, HCA and the Medical Society urged across-the-board waiver of F2F for New York given that the state’s entire Medicaid program functions under an 1115 “managed care waiver.” See DOH p. 2
INSIDE DOH Affirms F2f Plan...................................................................1 Statewide Health Care Facility Transformation Program Awards Announced......2 DOH Releases Guidance on 24-Hour/Live-In Cases........................................3 HCA Convenes MLTC/PACE Member Summit..................................4 HCA Participates in Executive Chamber Session on Priorities.................................5 CMS, DOH Conduct Session on the “Future of Integrated Care”....5 HCA Sepsis Initiative Continues to Draw State, National Engagement ..6 OIG Issues Work Plan Mid-Year Update....................................................7 Can’t-Miss Senior & Financial Manager’s Retreat in September: Register Today..8 DOH Issues Further FLSA Guidance for MLTC Plans..........................................9 LHCSA Statistical Report Workgroup Meet.................................................9
Paid Family Leave Regulations Adopted...................................................10 State Posts 2017 Hospice Residence Base Rates, RTR Add-Ons......11 DOH-Issued Emergency Preparedness Survey Due August 4th......11 HCA to Host Education Session on EP Essential........................12 CMS Updates Home Health Compare Data................................12 OMIG Posts NHTD Audit Protocols..............................................12 PHHPC Committee On Establishment and Project Review Meeting Held.....13 Potential Funding for TBI Housing Subsidy Payment Agency....................13 Provider Changes to Address New Medicare Cards with New Numbers..........15 Updated Hospital Notices Must be Used by August 28............................16 Resources...................................................................................16
The Situation Report: the Home Care Association of New York State DOH from p. 1 DOH has advised HCA that the Department has accepted our proposed managed care exemption, but has scaled it to traditional managed care models and not the additional levels of managed care (e.g., DSRIP, and bundled models) that we had proposed. Nevertheless, the exemption is anticipated to be extremely helpful in mitigating the additional burden associated with this added Medicaid F2F for home care. HCA has asked DOH to reconsider the F2F enforcement date, and to move the date to a reasonable period after the new guidance is made available to home care agencies and physicians. HCA has argued that to issue guidance after the July 1 date and to make enforcement retroactive would not be appropriate. Contact Al Cardillo with any questions at acardillo@hcanys.org.
Statewide Health Care Facility Transformation Program Awards Announced DOH Seeks Input on Next Round Last week, the state Department of Health (DOH) announced capital awards totaling just over $491 million from the statewide Health Care Facility Transformation Program. These awards are for applications submitted under the first round of this program, and are based on funding appropriated in both last year’s state budget that were secured by HCA and community health coalition partners, as well as this year’s budget. The HCA and partner effort resulted in the first round and $75 million minimum in the second round. Meanwhile, DOH is seeking input from stakeholders in its development of the next round of Health Care Facility Transformation grants. Comments are due August 17 and should be submitted to statewide.II.input@health.ny.gov. The program, administered by the Department of Health and the Dormitory Authority of the State of New York, is intended to help support the goals of the Delivery System Reform Incentive Program (DSRIP) which aim to reduce costs and improve
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
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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 Vice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz 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 & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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outcomes across the state. Of particular note is the DSRIP goal to reduce avoidable hospital visits by 25 percent by 2020. To that end, HCA and partners cited this goal extensively in our advocacy for both years’ set-asides for home and community based providers, in order to increase capital in support of the providers caring for patients in their homes and communities, and out of the hospital. The full list of awards is available at http://hca-nys.org/wp-content/uploads/2017/07/SHCFTP-ConsolidatedAward-List-pdf-7-17-17.pdf. When the call for applications for the next round of Health Care Facility Transformation Program applications is announced, HCA will notify the membership. Please contact HCA Policy staff with any questions.
DOH Releases Guidance on 24-Hour/Live-In Cases The state Department of Health (DOH) has released an initial guidance in response to concerns raised by HCA, providers, plans and other Associations on the delivery of 24-hour/live-in cases due to the Tokhtaman and other recent court decisions. The guidance can be http://hca-nys.org/wp-content/uploads/2017/07/ Live-In-Home-Care-Guidance-7-14-17.pdf. DOH’s guidance states: Pending a final resolution of this matter by the courts, or until notice is otherwise given, DOH and the Department of Labor expect providers to continue staffing and covering live-in cases in accordance with current Managed Care contracts, Medicaid agreements, MLTC Policy 14.08, and all applicable labor requirements. Live-in cases should not be converted to 24-hour continuous split-shift care unless the individual meets the criteria for this higher level of care. DOH also states that it, along with the state Department of Labor, “has been monitoring these cases, and will continue to evaluate whether action may be needed to prevent unnecessary disruption to home care services in New York State.” Background As relayed to members in various communications and education programs, the New York State Supreme Court, Appellate Division, First Department (in Nina Tokhtaman, etc. v. Human Care, LLC) held that live-in home care aides are not necessarily a category of employee who need to be paid for 13 hours of a 24-hour shift. According to the court, live-in aides who fall outside of that category would be entitled to be paid for each hour of a 24-hour shift. Other cases that include this issue are working their way through the courts, including Andryeyva v. New York Health Care, Inc., on which HCA submitted an amicus brief and on which oral arguments were held in mid-January. HCA has raised with DOH the potential detrimental effect of these court decisions on providers, plans, and consumers. HCA has also urged the Departments of Health and Labor to, in the Continued on next page
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Continued from previous page immediate term, guide providers and plans on how to handle services and billing for live-in patients amid the litigation and appeals, and in the overall picture, to ensure that providers, plans, consumers and the Medicaid system are financially protected in resulting policy outcomes. This new issuance of DOH guidance is a first step, and HCA appreciates the Department’s efforts on behalf of HCA and the system. For more information, contact the HCA Policy staff.
HCA Convenes MLTC/PACE Member Summit HCA convened a summit of its member Managed Long Term Care plans (MLTCs) this past week to examine priority concerns and needs, and discuss strategic planning goals. Priority areas included: · · · · · · · · ·
Rate and payment adequacy; DOH “disconnects” between divisions and bureaus impacting MLTC and state health policy; Workforce and workforce investment needs; Fair Labor Standards Act payments; Major implications of the 24 hour live-in litigation; Value based payment contracting; Quality and alignment of quality and performance metrics between plans and providers; data support; Compliance/control needs in certain program areas; and other.
HCA and MLTC members outlined plans for next steps. HCA has scheduled a second summit (for August 22 in Rochester) for MLTC/PACE members unable to attend last week’s session due to summer leave schedules. HCA will be combining input and recommendations from both sessions and will share the results of both with our plan members. MLTCs not attending last week and wishing to attend the next session (and not already registered for Rochester) should email HCA meeting manager Ms. Billi Wilson at bwilson@hcanys.org. Questions should be directed to HCA Executive Vice President Al Cardillo at acardillo@hcanys.org. In the meantime, HCA is preparing follow-up to the excellent ideas shared at this first summit and will be engaging plan members in content and strategy as we proceed. For further information, contact Al Cardillo at acardillo@hcanys.org.
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HCA Participates in Executive Chamber Session on Priorities HCA was invited along with key health care sectors to a meeting with the Governor’s office on priority areas of need and concern, looking ahead to the fall and eventual preparation for the 2018 legislative and budget sessions. Along with HCA, the meeting included the State Medical Society, Community Health Care Association, primary care provider organizations, nursing home and other long term care associations. HCA emphasized the critical issue of payment adequacy across the system, and the serious implications for all participants given the current underfinancing and constant new layers of program changes and mandates (including the labor/wage). HCA underscored the need for sound premiums to plans, rates to providers and wages to workers. HCA urged concrete steps and support to enable providers to partner and engage under the state’s reform policies including DSRIP and VBP models; we called for specific support for HCA collaboration proposals, including our Physician-Homecare Collaborative for Primary Care, Public Health and Medical Management. We further stressed the technology investment, emphasizing that neither system nor clinical integration are realistic without the technical capacity for robust health information exchange. HCA also called for regulatory streamlining the possibilities for increased efficiency, worker access, and worker retention from sensible relief. HCA provided examples of duplication and the advantages of remediation in these areas. HCA will be following up on this excellent opportunity we received to weigh in early and in a thoughtful process on priority needs in the field. For further information, please contact Al Cardillo acardillo@hcanys.org or Alexandra Blais at ablais@hcanys.org.
CMS, DOH Conduct Session on the “Future of Integrated Care” The Centers for Medicare and Medicaid Services (CMS) and State Department of Health (DOH) conducted a session with health system stakeholders on the status and future of integrated care. The session, held Thursday July 20 in NYC, is intended as the table-setter for what CMS and NYS plan as the basis for a new working group that will meet regularly between now and the end of the year to construct a “vision for the state’s integrated care programs after 2019.” State and CMS officials reviewed the different models in New York and in other areas of the country comprising capitated programs integrating clinical and care management services, as well as financing. Officials emphasized the desire to bring together all of the delivery and financing under integrated programs, promoting coordination of care and “triple aim”. DOH reiterated its desire to maximize the See CMS, DOH p. 6
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CMS, DOH from p. 5 opportunities under recent federal changes to support and expand Programs of All-Inclusive Care for the Elderly in the state. Participants directed an initial round comments and questions primarily to CMS, and focused on elements needed for truly aligned and workable systems. Among these elements were: · · ·
·
· · ·
Adequacy of payment; Alignment of quality metrics and goals; Regulatory and procedural alignment (HCA noted in particular how the new COPs are adding layers to an already compounded structure, and CMS’s need to realign regulations and procedures with its new models); Need to support technology integration and technology financing (HCA noted the lack of federal investment in this area outside of hospitals, the barriers to technology integration particularly for community based providers, and the need for both program and financial support for this goal); Importance of consumer input; Consideration special needs and pediatric populations; and more.
Officials indicated that next steps would be announced soon with regard to the formation of a workgroup, meeting schedule and task goals. For further information, contact Al Cardillo at acardillo@hcanys.org. HCA Sepsis Initiative Continues to Draw State, National Engagement HCA’s home and community based sepsis screen and intervention protocol continues to draw state and national engagement. Home care agencies within the state continue to enroll with HCA for authorized use of the sepsis tool, on Friday alone, HCA fielded inquiries from providers in Illinois, Ohio and Montana on the HCA tool. Also, the US Centers for Disease Control and Prevention (CDC) recently affirmed their continuing support for this initiative and have offered to assist in next rounds of educational outreach and presentations in New York. Last Friday, HCA met with representatives of the State Department of Health (DOH) and KPMG value based project directors who have asked HCA to conduct a full presentation and webinar on the sepsis tool for managed care organizations, managed long term care plans and others in September. In addition to the direct health and public health focus of the tool, DOH is eager to present the initiative’s potential role in achieving value based payment goals and plan-provider contracting. The presentation/webinar is being hosted by DOH and will be conducted by HCA and its sepsis initiative partners, including IPRO, National Sepsis Alliance, CDC and other. More information and details to follow. IPRO has developed a HIPAA compliant data portal and electronic method for HCA sepsis tool users to transmit data that HCA and IPRO will analyze and use in regular call-ins or webinars to support providers, profile home and community sepsis findings, evaluate experience, and contribute to best practices and policy development. HCA and IPRO will be scheduling an informational call or webinar to discuss the mechanics, a fall beta test of the reporting mechanism and a tentative start date for reporting aiming toward the first quarter of 2018. Continued on next page
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Continued from previous page This data will be unique in our state and nationally. HCA and DOH have an upcoming meeting to discuss an HCA proposal for how this data and state-collected hospital sepsis mortality data might inform an initiative whereby home care agencies are invited to further collaborate with hospitals to target high sepsis mortality in identified communities. If you are not enrolled, enroll! HCA members not yet users of the HCA sepsis tool can request authorization through HCA by emailing sepsistool@hcanys.org. For further information, please contact Al Cardillo acardillo@hcanys.org, Alexandra Blais ablais@hcanys.org or Laura Constable lconstable@hcanys.org.
OIG Issues Work Plan Mid-Year Update The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued its Fiscal Year Work Plan Mid-Year Update for 2017. The Work Plan is posted at: https://oig.hhs.gov/reportsand-publications/workplan/index.asp The Work Plan summarizes new and ongoing reviews and activities that OIG plans to pursue during the current fiscal year and beyond. It describes OIG audits and evaluations that are underway or planned, and certain ongoing legal and investigative initiatives. It also notes items that have been completed, postponed, or canceled and includes new items that have been started or planned since October 2016. The following are the most significant OIG updates that home health agencies (HHAs) should familiarize with: Consumer-Directed Personal Assistance Program Prior OIG work has shown vulnerabilities in personal care programs resulting in ineligible beneficiaries and Medicaid payments that do not comply with Federal and State regulations. The OIG will determine whether selected States made Medicaid payments for consumer-directed personal assistance program claims in accordance with applicable Federal and State regulations. High-Risk, Error-Prone HHA Providers Using HHA Historical Data For Calendar Year 2016, Medicare paid HHAs about $18.2 billion for home health services. CMS’s Comprehensive Error Rate Testing (CERT) program determined that the 2016 improper payment error rate for home health claims was 42 percent, or about $7.7 billion. Using data from the CERT program, the OIG will identify the common characteristics of “at risk” HHA providers that could be used to target pre- and post-payment review of claims. For further information contact HCA’s Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.
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Can’t-Miss Senior & Financial Manager’s Retreat in September: Register Today! Register by August 25; room reservations by August 5 Registration is now open for HCA’s popular Senior & Financial Manager’s Retreat at the scenic Mohonk Mountain House in New Paltz on September 7-8. This highly-anticipated program is for home care, hospice and MLTC CEOs, COOs, CFOs, finance managers or other senior officers involved in finance decision-making and implementation at your organization. We have several new program segments this year, along with annual updates on vital finance and reimbursement issues, including particularly well-timed opportunities to learn about federal health care developments, the 2018 home health prospective payment system proposal, Medicaid rate-setting and more. Top finance consultants, state Department of Health officials, data experts, and legal/governmentrelations representatives will all be on hand for the following sessions: · · · · · · · ·
Hot Topics in Home Care Finance Round-table Discussion State Department of Health Home Health and Hospice Reimbursement Update Know Your ‘Stats’ Workshop Federal Issues Update on Hospice and Palliative Care Building Contracts and Arrangements to Succeed in a Managed Care and VBP Environment HCA Overview and Policy Priorities that Impact Your Bottom Line Federal Update on Regulatory and Reimbursement Issues Building Better MLTC-Provider Relationships
About the Mohonk Mountain House The Mohonk Mountain House is an award-winning resort, with breathtaking views, the number-one spa in the U.S. (according to Conde Nast Traveler Magazine) and excellent farm-to-table dining. It also hosts: scenic hiking trails, a golf course, paddling on the lake, horse-back riding and other activities. Even with a robust program agenda, HCA has built-in some time for attendees to take advantage of these leisure activities during the retreat, which is a great way to unwind in between finance updates, ideas and guidance. Download the brochure at: http://hca-nys.org/wp-content/uploads/2017/07/HCA-Senior-FinancialManagers-Retreat-Brochure-2017.pdf Register online at: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012224.
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DOH Issues Further FLSA Guidance for MLTC Plans This week, the state Department of Health (DOH) issued a request to managed long term care (MLTC) plans to indicate which of the following options they will be taking in follow-up to Fair Labor Standards Act attestations and funding: 1. Plan will not be attesting and all FLSA funds will be returned to the state. 2. Plan has attested, but will only be utilizing a portion of the funds allotted. Plan will be returning the following amount: ___________ 3. Plan has attested, and will utilize the entire amount allotted. 4. Plan is currently out of compliance with attesting, but is actively engaged in amending provider rates and is in the process of determining how much of the funds will be utilized. The DOH request asks that plans send their response to FLSA@health.ny.gov by August 3. DOH advises: ”if your plan is still reviewing rates as described in option 4, the plan will need to have signed the original attestation and note whether the entire amount allotted will be utilized, or a portion will be returned. If a portion is being returned, as described in option 2, please indicate the amount being returned.” DOH further advises that Instructions on how funds will be returned to the Department will follow in further guidance from the Department. In mid-April, DOH had posted guidance on funds intended for use in meeting the 2015 FLSA changes, including an April 2017 Dear Colleague Letter on FLSA Implementation and accompanying attestation forms, available at https://www.health.ny.gov/health_care/medicaid/redesign/fair_labor_standards_act.htm.
LHCSA Statistical Report Workgroup Meets On July 10, the LHCSA Statistical Report Workgroup met for the third time. HCA and some LHCSA members, as well as other Associations are part of the group. As a reminder, the goals of the Workgroup are to: · · · · ·
Increase compliance rates for the LHCSA Statistical Report Capture data relevant to service delivery Ensure quality data is collected in a timely manner Ensure terminology in the report is used universally across the home care industry Streamline data reporting
Based on feedback from HCA LHCSA members, we have already submitted comprehensive comments that advocated for DOH to: reduce the amount of data requested and consider our specific recommendations for most sections; provide more comprehensive and detailed instructions and definitions of key terms; allow LHCSAs with multiple licenses to submit one report; provide adequate time to implement any changes; and utilize an excel file template for agencies. See LHCSA p. 10
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The Situation Report: the Home Care Association of New York State LHCSA from p. 9 At the July 10 meeting, the state Department of Health (DOH) reviewed every section of the Statistical Report and sought advice on what terms to define; revisions to streamline it; and new information to request. In response to requests by HCA and other stakeholders, DOH said it would hold a webinar on a revised Statistical Report before a revised version is posted for completion (2018). DOH announced that it intends to add some questions about: the direct care workforce to identify turnover, waiting lists and shortages; aide training programs; and fiscal intermediaries under consumer directed programs. The meeting also included a demonstration and discussion about a new Universal Data Collection System that is being used to collect data over various health sectors, and its applicability to LHCSA services. Under this system, LHCSAs would download free DOH software and enter data on Excel-like spreadsheets. Users will have distinct roles similar to the Health Commerce System. Users would be able to run edits before submitting and the software will identify missing information and alert the user if the data does not meet certain conditions established by DOH.DOH hopes to conduct a test run of this system sometime later this year and will examine any problems identified. Additionally, DOH reported a second round of enforcement letters sent to 29 agencies that had not submitted 2015 LHCSA Statistical Reports. So far, only three of the 29 had requested to have the Report reopened; five of the 29 have recently closed. DOH intends to release the 2016 LHCSA Statistical Report in August; it will be similar to the 2015 Report. DOH hopes to incorporate some of the changes being discussed as part of this Workgroup into the 2017 Report, expected sometime in the summer of 2018. The next meeting of the LHCSA Statistical Report Workgroup will be in the fall, at which time HCA will provide further updates. For more information, contact Andrew Koski at (518) 8100662 or akoski@hcanys.org, or Patrick Conole at (518) 8100661 or pconole@hcanys.org.
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Paid Family Leave Regulations Adopted The New York State Workers’ Compensation Board has issued final regulations to implement the state’s new Paid Family Leave program. The regulations are at http:// www.wcb.ny.gov/PFL/pfl-regs.jsp. The final regulations make some minor changes to a prior version highlighted in our May 30 Situation Report. The state Department of Financial Services (DFS) had also issued final regulations in June (see June 5 Situation Report). As communicated in numerous articles and a June education program, when fully implemented, Paid Family Leave (starting January 1, 2018 and phased in over 2018 to 2021), will provide employees up to 12 weeks of paid family leave in any given 52week benefit period to: 1) care for a family member (including a child, parent, grandparent, grandchild, spouse or domestic partner) with a serious health condition; 2) bond with an employee’s newborn or newly placed adoptive or foster child during the first 12 months following birth or placement; or 3) address any qualifying exigency to a spouse, domestic partner, child or parent who is serving on active military duty. Paid Family Leave is employee-funded, through payroll deductions, with the exception of any administrative costs incurred by employers. Employee participation is also mandatory, with certain exceptions. Benefits will be phased in, starting on January 1, 2018, at which time employees Continued on next page
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Continued from previous page may receive up to eight weeks of paid benefits in 2018. Benefits will be paid at 50 percent of the employee’s average weekly wage, not to exceed 50 percent of the state average weekly wage. These benefits will gradually increase until January 1, 2021, when they will provide 12 weeks of coverage at 67 percent of the employee’s average weekly wage. In June, DFS established the premium rate for Paid Family Leave benefits and the maximum employee contribution for coverage (beginning January I, 2018) shall be 0.126 percent of an employee’s weekly wage up to and not to exceed the statewide average weekly wage.
State Posts 2017 Hospice Residence Base Rates, RTR Add-ons The state Department of Health (DOH) has announced the approval and publication of Medicaid hospice residence base rates as well as corresponding Recruitment, Training and Retention (RTR) add-ons for the current calendar year (January 1 to December 31, 2017). Providers should have received a Dear Administrator Letter (DAL) with the rates attached. These rates will soon be posted to the Department’s website at: https://www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/ hospice_residence_rates_2017.htm. As reflected in the spreadsheet, the base rates represent 94 percent of the weighted average calendar year Medicaid rates of nursing facilities in each wage equalization factor (WEF) region. The rates also include a payment add-on of $9.92 per day for agencies that have filed certifications for RTR. These funds are solely for the purposes of improving recruitment, training and retention of non-supervisory personnel with direct patient care responsibility. The rates were forwarded to the Division of Program Operations and Systems for payment. Specific questions about the rates can be directed to DOH’s Russ Smith at (518) 473-4421. For further information contact HCA’s Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.
DOH-Issued Emergency Preparedness Survey due August 4th On July 3rd the state Department of Health (DOH) deployed a Coalition Member Training Needs Assessment Survey to all hospitals, long term care, community health centers, home care, and adult care with a completion date of close of business on Friday, August 4th. This survey does not apply to facilities/agencies within the 5 boroughs of New York City. Instructions on how to access the survey are located on the HERDS Main Menu within the Health Commerce System (HCS). Additional information, including contact information for support, is located within the survey form. HCA and other associations have requested additional information and guidance from DOH, but have been instructed to inform providers to refer any questions about this survey to DOH Office of Health Emergency Preparedness (OHEP) Training Manager at: judith.lecomb@health.ny.us. DOH is tracking all inquiries. You can also send questions to Alex Blais at ablais@hcanys.org and they can be forwarded to DOH.
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HCA to Host Education Session on Emergency Preparedness Essentials In direct response to needs voiced by the membership and the growing focus on Emergency Preparedness for agencies, HCA will be conducting a conference in Albany on Wednesday, September 27th, entitled “Emergency Preparedness Essentials for Home Care & Hospice.” This one-day session, which builds upon intensified efforts to provide guidance in preparation for the new federal emergency preparedness requirements, will be packed with critical insight from emergency preparedness experts including representatives from the state Department of Health (DOH) Office of Health Emergency Preparedness, DOH Office of Primary Care and Health Systems Management, as well as the Department of Homeland Security’s Office of Emergency Management in New York State. Attendees will have an opportunity to interact directly to a panel of DOH representatives in a Town Hallstyle session in the morning, receive a deep-dive CoP review from DOH’s Lead for Healthcare Preparedness and Response and surveillance unit representative, participate in a table top exercise that is expected to satisfy an agency’s secondary training exercise requirement, in addition to learning about other training tools for agency staff. Registration for this event will be released soon, and any questions can be directed to Alex Blais at ablais@hcanys.org.
CMS Updates Home Health Compare Data The Centers for Medicare and Medicaid Services (CMS) has recently updated its scores on the Home Health Compare website at: https://data.medicare.gov/data/home-health-compare. Home Health Compare has information about the quality of care provided by “Medicare-certified” home health agencies throughout the nation, as they define it. The website is most often referenced as a consumer-friendly site to help consumers and their families make health care provider decisions.
OMIG Posts NHTD Audit Protocols The state Office of the Medicaid Inspector General (OMIG) has posted revised Nursing Home Transition and Diversion waiver audit protocols. These new NHTD protocols apply to all services delivered prior to July 11, 2017. HCA, along with LeadingAge NY and the New York State Association of Health Care Providers, submitted comments on two prior drafts of these audit protocols. The draft audits cover many areas, including: no documentation of service or recipient record; missing service plan; billing more hours than documented or authorized; billing an incorrect rate code; failure to meet service coordination requirements; exceeding caseload limit for service coordination; not completing provider training; services provided by unqualified staff; failure to complete annual in-service training for home and community support services staff; missing evidence of nurse supervision visit; failure to obtain authorized practitioner’s signature within required time frame; and more. Continued on next page
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Continued from previous page We provided feedback on a number of protocols and recommended: · · · · ·
OMIG consider “extenuating circumstances” beyond the home care provider’s control before determining that a protocol is not met; Flexibility in determining when claims would be denied if a protocol is not met; Corrections of any inaccuracies; Changes to align with current state Department of Health policies; and Necessary clarifications.
While OMIG did not make any revisions based on our comments on the most recent draft, it had made some revisions to an earlier draft based on our prior comments. The protocols are at The protocols are at https://omig.ny.gov/images/stories/audit_protocols/ NHTD%20Protocols%20-%20Posted%20Copy%2007-10-2017.pdf. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
PHHPC Committee on Establishment and Project Review Meeting Held
Potential Funding for TBI Housing Subsidy Payment Agent
Last week there was a meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review. The agenda, along with supporting documents, can be found at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/ meetings/2017-07-20/.
The state Department of Health (DOH) has issued a request for information (RFI) related to its Traumatic Brain Injury (TBI) Waiver Housing Subsidy program. DOH is seeking to increase the size of the list of potential payment agent bidders for the TBI Waiver Housing Subsidy Program.
The agenda included applications by:
The RFI may result in a Request for Proposals (RFP) resulting in a contract which would, at a minimum, be for eighteen months, with optional renewals starting on or about January 1, 2018. On January 1, 2019, the TBI Waiver is expected to transition into managed care, which will significantly change the role of the payment agent.
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One entity to purchase a Certified Home Health Agency (CHHA) that serves New York City and to add homemaker, housekeeper, and personal care to its authorized services; 39 entities to establish new Licensed Home Care Services Agencies (LHCSAs); Two entities to establish new LHCSAs affiliated with Assisted Living Programs; and Four LHCSAs for changes of ownership. See PHHPC p. 14
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The TBI Waiver Housing Subsidy Program is primarily a rental subsidy program available to See Potential p. 14
The Situation Report: the Home Care Association of New York State PHHPC from p. 13 Both the CHHA application and the entire group of LHCSA applications were approved. However, there was a discussion by the PHHPC Committee on Establishment and Project Review about the large number of LHCSA applications. One Committee member urged DOH to evaluate the process for establishing LHCSAs. Another member asked if DOH had any data on the “true” need for LHCSAs in the state. DOH said that a soon-to-be established workgroup will be examining whether there should be a need methodology for LHCSAs and will be looking at need methodologies for other providers. DOH also said that it is looking at the option of establishing a recertification process for LHCSAs (this was also discussed at a past meeting of the LHCSA Statistical Report Workgroup whose work has been covered in previous Situation Report articles). DOH also pointed out that most of the new LHCSA applications were part of a backlog going back to 2015. The next full PHHPC meeting is August 3.
Volume 2, No. 28 July 24, 2017
Potential from p. 13 participants in the TBI program who meet established eligibility criteria, including demonstrated financial need. The Housing Subsidy Program, associated with the waiver, aims to reduce or avoid institutionalization and in turn, improve participants’ lives, reduce Medicaid expenses, and support the Supreme Court mandate in Olmstead v. L.C. to provide state services to people with disabilities in the most appropriate, integrated setting. The minimum qualifications for this potential RFP are: ·
At least four years’ experience administering financial management and/or payment systems related to community based services on a statewide scale.
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At least three years’ experience working with state governments, non-profit agencies, advocacy organizations, and/or health and human services organizations as a payment agent.
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At least three years’ experience issuing year end 1099 forms and other applicable Internal Revenue Service (IRS) tax requirements.
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At least two years’ experience processing at least 1,500 transactions per month for multiple clients using direct payment systems (paper and/or electronic funds transfer).
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Possessing a line of credit to cover pass-through service expenditures in excessive of $1.5 million.
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Possessing an established electronic payment processing systems with specific standards and features (see the RFI for details).
Interested parties should respond by July 24, 2017 to this RFI with a letter expressing their interest and briefly outlining their ability to meet the minimum qualifications listed. Letters should be addressed to: Maribeth Gnozzio Bureau of Community Integration and Alzheimer’s Disease, Division of Long Term Care NYS Department of Health 1 Commerce Plaza, Room 1605 Albany, NY, 12210 tbi@health.ny.gov
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 28 July 24, 2017
Provider Changes to Address New Medicare Cards with New Numbers The Medicare Access and CHIP Reauthorization Act of 2015 requires the U.S. Centers for Medicare and Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to patients in April 2018. CMS advises providers that they may need to change your systems to: ·
Accept the new Medicare number (Medicare Beneficiary Identifier or MBI). Providers should use the MBI format specifications at https://www.cms.gov/Medicare/SSNRI/Understanding-the-MBIwith-Format.pdf if you currently have edits on the current Health Insurance Claim Number (HICN).
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Identify patients who qualify for Medicare under the Railroad Retirement Board (RRB). You will no longer be able to distinguish RRB patients by the number on the new Medicare card. You will be able to identify them by the RRB logo on their card, and CMS will return a message on the eligibility transaction response for a RRB patient. The message will say, “Railroad Retirement Medicare Beneficiary” in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA, at https:// www.palmettogba.com/palmetto/providers.nsf/DocsCatHome/Railroad%20Medicare.
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Update your practice management system’s patient numbers to automatically accept the new Medicare number or MBI from the remittance advice (835) transaction. Beginning in October 2018, through the transition period (see https://www.cms.gov/Medicare/SSNRI/Index.html#target), CMS will return your patient’s MBI on every electronic remittance advice for claims you submit with a valid and active HICN. It will be in the same place you currently get the “changed HICN”: 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).
If you use vendors to bill Medicare, contact them if they haven’t already shared their new Medicare card system changes with you; they can also tell you how they will pass the new Medicare number to you. Visit the New Medicare Card Provider webpage (https://www.cms.gov/Medicare/SSNRI/Providers/ Providers.html) for the latest information.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 28 July 24, 2017
Updated Hospital Notices Must Be Used by August 28 The U.S. Centers for Medicare and Medicaid Services (CMS) has posted updated hospital notices and requires that they be used by August 28. These notices include the Important Message from Medicare (IM), CMS-R-193, and the Detailed Notice of Discharge (DND).CMS 10066. Hospitals are required to deliver the Important Message from Medicare to all Medicare beneficiaries (Medicare fee-for-service beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the DND from the hospital or their Medicare Advantage plan, if applicable. Copies of each form are at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ HospitalDischargeAppealNotices.html. Home care providers may want to familiarize themselves with the forms in case their patients are hospitalized and they get questions from consumers or family members about their discharge rights.
Resources ·
“How to use a pooled SNT to eliminate the Medicaid spend-down,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/6/
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“Medicaid Transportation in NYS,” by the New York Legal Assistance Group http://www.wnylc.com/ health/entry/143/
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“Health, U.S., 2016,” by the U.S. Department of Health and Human Services https://www.cdc.gov/nchs/ hus/
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“Veterans and Health in New York State,” by the NYS Health Foundation http:// nyshealthfoundation.org/uploads/resources/veterans-and-health-in-new-york-state-july-2017.pdf
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“HealthWatch: Medicaid Managed Long-Term Care in New York, Ongoing Growth in the Era of Statewide Implementation,” by United Hospital Fund https://www.uhfnyc.org/assets/1571
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“Medicare Advantage Program Integrity: CMS’s Efforts to Ensure Proper Payments and Identify and Recover Improper Payments.,” by the Government Accountability Office http://www.gao.gov/assets/690/ 685934.pdf
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“The Facts on Medicare Spending and Financing,” by the Kaiser Family Foundation http://files.kff.org/ attachment/Issue-Brief-The-Facts-on-Medicare-Spending-and-Financing
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“Telehealth: Use in Medicare and Medicaid,” by the Government Accountability Office http:// www.gao.gov/assets/690/685987.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org
Senior and Financial Manager’s Retreat
September 7-8, 2017 Mohonk Mountain House New Paltz, NY
Thanks to our Sponsors!
Thanks to our Exhibitors!
Interested in participating as an exhibitor or sponsor at this event? Contact Billi Wilson at 518-810-0666 or via email at bwilson@hcanys.org 2
September 7-8, 2017 – Mohonk Mountain House, New Paltz, NY
Senior and Financial Manager’s Retreat
Getting Awayfrom it all!
Mohonk Mountain House Rates and Other Information Your combined hotel and event registration rate includes your room, all meals, breaks, valet parking and meeting amenities. A single room rate is $339 per person, per day; double rates are $241 per person, per day; plus local taxes and a 12% administrative fee.
Things to do at the Mohonk Mountain House Activities listed below are at no charge (except where noted) for overnight guests: • Visit the Barn Museum • Take a Row Boat, Paddle Boat, Canoe or Kayak out on the Lake • Play Croquet • Tour the award-winning Gardens & Maze • Explore the Greenhouse • Discover 85 Miles of Hiking (hike to skytop is recommended) • Challenge Colleagues to a game of Horseshoes • Lawn Bowling • Platform Tennis • Rock Scrambles • Shuffleboard • Basketball and Volleyball • 18-hole putting green
All Mohonk reservations should be made by August 5 to receive the HCA conference rate and be guaranteed a room. After this date, higher rates will apply based on availability. To make your room reservation, please call:
800-772-6646 and ask for the HCA rate.
The following are activities available for a fee and advanced reservations are recommended. The Spa at Mohonk Mountain House – Named number one resort spa in the United States by Condé Nast Traveler Magazine!
Not Staying Overnight at Mohonk? Since this is a remote resort in the mountains, and Mohonk wants to also be prepared for those not staying overnight, a “per-day rate” of $105 is charged. This day rate includes lunch, breaks, meeting amenities, and selfparking. Day guests must register with HCA as well in order to access the property. Please include the fee(s) with your HCA registration (page 7).
HCA registered participants receive a 15% discount on spa services and spa retail purchases on Wednesday, September 6 & Thursday, September 7. Make sure to mention that you are with HCA when making your reservation to receive this discount. For Spa information and reservations call 877-781-1590. Golfing: Reservations for Tee Times are required and may be reserved up to 30 days in advance. Call the Pro Shop at 845-256-2154. Horse Back Riding: Contact the Stables at 845-256-2784
Plus: Receive 10% off purchases in the Gift Shop!
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Senior and Financial Manager’s Retreat AGENDA Thursday, September 7 The Mountain Lake Conference House 8:30AM Registration Opens 9:00 – 10:00AM Hot Topics in Home Care Finance Roundtable Discussion Panelists: Keith Boroch, Assistant Vice President of Post Acute Consulting, McBee Associates Paul Essner, CFP, CLU, ChFC, Partner, TSG Financial David Birnbaum, Executive Vice President, NY Business Unit, Sandata Technologies Moderated by Patrick Conole, Vice President, Finance & Management, HCA HCA is changing the batting order for this year’s Retreat and opening up with a session that includes three industry experts providing their insights on current and emerging industry trends, challenges and tips for avoiding costly pitfalls and achieving financial success. During this session participants will hear how the 21st Century Cures Act will affect home care providers; narratives of successful partnerships amongst acute and post-acute providers such as home care and hospice; and how congressional actions on ACA will impact the business of running a home health agency. 10:00 – 11:00AM NYS DOH Home Health & Hospice Reimbursement Update Daniel Carmody, Director, Bureau of Managed Long Term Care Rate Setting Michael Ogborn, Deputy Director, Division of Finance and Rate Setting Office of Health Insurance Programs, New York State Department of Health (Invited) Hear from leading reimbursement experts at New York State’s Health Department about various reimbursement policy priorities, including updates to the rates that affect MLTC plans as well as home care providers. Participants will also hear the latest about the state’s plans for upcoming rate adjustments to account for mandatory minimum wage increases throughout the state, FLSA and associated QIVAPP rate adjustments as well as next steps in the move to Value Based Payments. Lastly, participants will learn about possible revisions to the Medicaid Managed Care Operating Reports (MMCORs) and a new provider reconciliation report that coincides with ongoing and future minimum wage rate adjustments. 11:00 – 11:15AM Break
11:15AM – 12:30PM Breakout Sessions
Federal Issues Update on Hospice and Palliative Care
Know Your ‘Stats’ Workshop Conference House
East Dining Room (Main Building)
Michael Freytag, Managing Director, BlackTree Healthcare Consulting
Katie Wehri, CHPC, Director of Operations Consulting, Healthcare Provider Solutions
In this session, participants will learn how to view their agency data by accessing CMS and other useful sites. The speaker will also discuss the importance of using this data to create benchmarks that, when tracked, can drastically improve financial and clinical outcomes. This session will also focus on common obstacles encountered while determining these benchmarks, and we will spend time focusing on how to overcome these obstacles by discussing the role technology plays in your current operations.
Hear from one of the nation’s most valued federal hospice and palliative care experts about the provisions and details of the federal hospice payment rule, with a particular focus on federal hospice compliance, regulatory and reimbursement changes and proposals as well as new opportunity areas in the Medicare program for hospice programs.
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September 7 – 8, 2017 – Mohonk Mountain House, New Paltz, NY
AGENDA Thursday, September 7 – continued The Mountain Lake Conference House 12:30–1:45PM Network with Your Peers over Lunch in the Main Dining Room 1:45 – 3:00PM Building Contracts and Arrangements to Succeed in a Managed Care and VBP Environment Nancy Sever, Principal, Hinman Straub Meghan McNamara Principal, Hinman Straub This session will offer technical essentials and program assistance to home care providers and plans for contractual arrangements that will enable home care and plans to effectively partner in the mandated environment of managed care and VBP. 3:00 – 5:00PM It’s Time to Relax and Recharge! In an environment of constant change and stresses, home care leaders need time to recharge in order to maximize performance and focus. This is why we’ve carved-out time for attendees to participate in leisure activities of their choice at our conference location, which is one of the most beautiful mountain retreat settings in the Northeast! Use this time to visit the exceptional Mohonk Mountain House Spa, hike the beautiful grounds, kayak on the pristine lake, check out the renowned golf course, or just relax on one of the many porches and outdoor venues offering a scenic view. 5:00–6:15PM Networking Reception – The Porch HCA is hosting a cocktail reception on the beautiful porch of the Mohonk Mountain House. Join us for a cocktail, and chat with staff and colleagues. 6:30PM Dinner – Main Dining Room Enjoy one of the most sumptuous dinners in the Hudson Valley! The Mohonk Dining Room is famous for its array of delicious menu offerings using local “farm-to-table” ingredients that will satisfy every palate. PLEASE NOTE: Dinner service at The Mohonk is by reservation only. HCA’s group dinner reservation is for 6:30 p.m.; all participants must arrive at the dining room at that time.
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Senior and Financial Manager’s Retreat AGENDA Friday, September 8 The Mountain Lake Conference House 7:30–8:30AM HCA’s Data Workgroup Breakfast (invitation only) 7:30–8:30AM Breakfast – Main Dining Room 8:30–9:30AM HCA Overview of Policy Priorities that Impact Your Bottom Line HCA’s Policy and Executive Team Learn what your association is doing to support the financial stability of New York’s home care provider community. This session will discuss the top-tier federal and state policy initiatives affecting providers, reinforcing the engaging and informative dialogue throughout the Retreat on your most pressing financial problems, your questions, and your biggest organizational challenges. 9:30–10:45AM Federal Update on Regulatory and Reimbursement Issues Colin Roskey, Principal, Lincoln Policy Group and Partner at Scully, Roskey & Missmar Washington, D.C.-based federal home health policy expert Colin Roskey is one of the most knowledgeable voices on Medicare home health and hospice regulatory and reimbursement issues. We are delighted that he is available to provide an overview of the national healthcare landscape as well as provide highlights of key components of the proposed CY 2018 home health prospective payment system (PPS) and FY 2018 Hospice final rule. Mr. Roskey will also present on other regulatory items percolating at the federal level including opportunities to revise the current face-to-face regulations and the upcoming home health Conditions of Participation. 10:45–11:00M
Break
11:00AM–12:15PM Building Better MLTC-Provider Relationships Panelists TBA Panel Moderator: Al Cardillo, Executive Vice President, HCA Effective partnership is vital to the success of MLTC and home care contractual relationships. During this session, participants will hear from two MLTC-home care contractual partnerships (one upstate and the other downstate) that have worked well and benefited both entities. Participants will hear firsthand from panelists on how the plan-provider partnerships can be successful, along with an opportunity to ask questions and have an open discussion with the moderator and panelists. 12:15PM Adjourn and Lunch-To-Go A box lunch will be provided for you to enjoy at the resort or as you head for home.
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Senior and Financial Manager’s Retreat September 7-8, 2017 Mohonk Mountain House New Paltz, NY The registration fee includes two days of expert speakers and handout materials, plus breaks, a reception and lunch on the final day that is not included with your overnight room package. Mohonk Resort rooms/meals are additional – see page 3 for details.
HCA Cancellation
REGISTRANT INFORMATION – Please register by August 25
Policy
Name: ______________________________________________________________________________________ Title:_________________________________________________________________________________________ Agency:_____________________________________________________________________________________ Address:_____________________________________________________________________________________ City/State/Zip:_______________________________________________________________________________ Phone:________________________________ Ext._________ Fax: ____________________________________ Email: _______________________________________________________________________________________ (Required)
HCA REGISTRATION FEE ____ Member Provider
$299
____ Associate Member/Vendor
$399
____ Non-Member Provider
$399
____ Non-Member Vendor
$599
HCA registration cancellations received by August 24 are refundable less a 25% administrative fee. No refunds will be issued after this date. Cancellations must be received in writing at info@hcanys.org. Substitutions are permitted. Please note Mohonk’s cancellation policy when making your reservation.
MOHONK “DAY ONLY” RESORT FEE ____ I will not require overnight accommodations, but will require a Mohonk “Per-Day Only” pass at $105 per day.
Total: $_________ PAYMENT – Please check method of payment: ________MasterCard
_______VISA
______American Express
______Check*
*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by August 31. ____________________________________________________________________________________________ Card Number ____________________________________________________________________________________________ Expiration Date Security Code ____________________________________________________________________________________________ Mailing Address of Card Holder ____________________________________________________________________________________________ City, State, Zip ____________________________________________________________________________________________ Name on Card ____________________________________________________________________________________________ Authorized Signature
FAX this form to 518-426-8788 or register online at www.eventville.com/hcanys 7
Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________