FALL 2015 MEMBER, LEGISLATIVE AND BUDGET UPDATE

2015-2016 BOARD ELECTIONS

Four county positions up : Kim Cobaugh, Molly Hess, Frank Geramita, Louann Simpson

Eight total positions remain on for another year Jim Shadduck (past president, Bradford County Manor Terry Brennan (president-elect), Berks Heim Rich Adams, Southwestern Veterans Center Al Alison, Baptist Homes Jen Eslinger, Conestoga View Nancy Pastorius, TCU Barbara Raymond, PA Soldiers and Sailors

Nominations: Kim Cobaugh, Administrator, Communities at Indian Haven Jasen Diley, CEO, Rouse-Warren County Home Frank Geramita, Administrator, Lafayette Manor Molly Hess, Administrator, Philadelphia Nursing Home Louann Simpson, Administrator, Valley View Nursing Home

Additional nominations? Discussion?

FY 2014-2015 Year-end Budget Highlights:• Facility Dues increased by $24,000• Spring Conference +12,000 over budgeted,

+16,000 from last year; Expense • Received $72,000 from PELICAN• Net Profit expected to be $29,000

• Will bring reserve back up

• Start of increase in affiliate fee of 4-5 percent each year through 2020

• FY15-16 -$206,000 • FY 20-21 - $262,350

• Increase in conference expenses• Facility quality • Number of attendees• Keynote speakers• Vendor shows• Should translate into increased conference income

FY 2015-2016 Budget Highlights

• Projected increase in member numbers marketing in 2015-2016

• Back to $52,000 from PELICAN• Increased Conference Revenue• Net projected profit at year’s end of

$8,000

FY 2015-2016 Budget Highlights

BENEFITS

Member Benefits Update: Website – sign up for members only section Health Exchange – HDH Insurance Group Purchasing Option (GPO) – Amerinet Regional Meetings Some Conference Changes:

Keynote New and improved materials

ADVOCACY

Member Benefits Update (continued) : IGT HB 1062 Budget Adjustment Factor MLTSS Improved partnerships

ACCOMPLISHMENTS FOR 2014-2015:

New and improved PACAH website Improved conference program with advertising availability Improved member directory (separate pocket addition) with emails and

now also online Added Newsclips and Blasts for important updates Instituted a Spring Vendor Show with improved prizes and vendor directory Offer advance Vendor registration at prior Vendor show Instituted a wine outing with sponsorship and wine glasses Increased sponsorship opportunities Launched a PACAH Health Exchange with HDH Insurance Launched a PACAH sponsored GPO with Amerinet Added PACAH committees (MLTSS, Business Member Advisory, Marketing)

to provide better feedback from membership Instituted Regional Meetings with participation from Department of Health

(DOH) Launched a Facebook page; LinkedIn page, and Twitter account

Changed bylaws to allow non-county members full-voting membership status

Changed logo and name upon direction of board and marketing committee to better reflect changing needs of association

Have increased conference attendance by 25-30 percent with the last two conferences selling out

Have increased vendor show participation by 35 percent Created member incentive (free conferences) for referring new members Created marketing items – banners/displays for registration; professional

folders; tablecover, marketing flyers, etc. Added a Meeting and Marketing Manager position with increased

responsibilities Added a PACAH marketing intern to assist and improve conferences and

marketing

ADVOCACY AND LOBBYING “WINS”

Regular meetings with DHS staff and Sellers Dorsey to discuss ways to increase funding for county nursing homes including the potential for limited IGT

Increase in MDOI from Assessment for county homes

Introduction of HB 1062 by Representative Killion Held Commissioner break-out at CCAP

Conference entitled “How to run your County Nursing Home like a business.”

Creation of Managed Long Term Services and Supports (MLTSS) Committee to help PACAH address implementation of MLTSS in Pennsylvania

Appointment of President Terry Barley on MLTSS Sub-MAAC committee

Sample advocacy letters available for county and private homes

Used county home study to advocate for county homes’ priorities including increased rates; elimination of county share; increased funding

Maximized partnerships and advocacy with

commissioners and legislators

Informational session with the House Aging and Older Adults Committee on County Nursing Homes

Meeting with new Department of Human Services Secretary (DHS) – Ted Dallas to discuss nursing home funding and the impact of county nursing home privatization

Significantly improved partnership and communication with CCAP

Successfully opposed the proposed 2015-2016 BAF changes

ACTION PLAN 2015-2016 HIGHLIGHTS

Continued focus on advocacy – rates, IGT, BAF, Assessment, MLTSS

Further partnering with legislators and commissioners

Focus on bringing in new members – including better referral incentives

• Newsletter• Website• Awards• Webinars

LEGISLATIVE AND BUDGET UPDATE FY 2015-2016 Budget Impasse

Governor Wolf proposed budget March 2015

The increased funding is largely directed toward basic and higher education, coupled with offsets in the school property tax. Funds are generated by enactment of a severance tax on natural gas, an increase in the income tax from 3.07 percent to 3.7 percent, a higher sales tax from six percent to 6.6 percent, coupled with a broader base (including SNF services) and applying new taxes to tobacco products.

LEGISLATIVE AND BUDGET UPDATE FY 2015-2016 Budget Impasse

In May, HB 1192 introduced in the legislature. Contained same funding as 2014-2015

On June 26, House and Senate Republican leaders announced legislative budget agreement, amended into HB 1192

The budget included funding for nursing homes at relatively the same amount as the Governor's proposed budget (no rate increase).

While there is a slight increase over last year's funding (5 percent) in the long term care line item, there are also decreases in one-time transfers from the lottery and tobacco funds.

The Home and Community Based Services (HCBS) line item was increased approximately 30 percent, but there was also a decrease in one-time lottery fund transfers to HCBS reducing the amount of this increase.

LEGISLATIVE AND BUDGET UPDATE FY 2015-2016 Budget Impasse

July 1, Governor Wolf vetoes HB 1192 in its entirety

Creates budget impasse – PA is prohibited from making any payments

What will be paid? Health care services paid for through Medical

Assistance, for hospitals, other healthcare providers and nursing homes

HCBS – attendant care Medicare Part A and B premiums

LEGISLATIVE AND BUDGET UPDATEFY 2015-2016 Budget ImpasseWhat won’t be paid? “Most payments to vendors or to grantees

for programs or expenditures incurred during FY 2015-16 that are authorized through the budget will be delayed until a budget is approved”

Example: P4P, non-public supplemental MDOI, etc., county MDOI, Assessment MDOI

LEGISLATIVE AND BUDGET UPDATE

FY 2015-2016 Budget Impasse On August 25, House Republican leadership attempted to

override 20 of the line all of which failed by a vote of 115-83 (a 2/3 majority is needed to override a veto), with Republicans voting in favor and Democrats voting against.

This week, SB 1001 was introduced, a stopgap budget bill Two nursing home line items included, non-public MDOI and

county supplemental (DE) “not viable”

We have seen our first lawsuit – PA Coalition of Children, Youth and Family Services (PCCYFS) provide services to at risk children and families in child welfare,

juvenile justice and behavioral health system deemed non essential

WHAT CAN YOU DO?????

• Write to legislators – will have sample letter on website

• Urge them to resolve the impasse to assure core human services programs are not jeopardized (long term care)

• Also continue to urge them to support long term care funding

• Keep track of impact and share with PACAH

RATES Being paid at April 2015 Rates (posted

on OLTL website) http://www.dhs.state.pa.us/provider/doi

ngbusinesswithdhs/longtermcarecasemixinformation/rates/index.htmFacebook Page

July proposed rates on website inaccurate

BUDGET ADJUSTMENT FACTOR

DHS proposed changes Based on high MA Occupancy and MA

Day One admission Public comment period –PACAH

successfully opposed, DHS decided not to move forward

Will be discussing changes this upcoming year

• Discussions continue with state on this, attempts to accurately calculate net

• Negotiating the return of left-over CPE funds

• Cannot move forward without the budget in place

• Good feedback from commissioners/members

IGT/CPE

NURSING HOME ASSESSMENT REDESIGN

B1/B2 test not met Workgroup New factors – high MA Occupancy;

increase in county payment April – draft public notice

HB 1062

• Introduced April 22 by Representative Killion (Del. Co.)

• Would eliminate the county share• 10% non-federal portion of Medicaid costs

counties are required to pay• $20 million• In House Health and Human Services

Committee• ALL MEMBERS ASKED FOR

ADVOCACY/SUPPORT

MLTSS

• Webinars – monthly• Website -

http://www.dhs.state.pa.us/foradults/managedlongtermsupports/

• Sub-MAAC, PACAH President Terry Brennan has been appointed

• Comments due July 2015 (view PACAH’s at www.pacahpa.org)

• RFP to be released October 2015• First enrollment January 1, 2017 in the Southwest• PACAH MLTSS Subcommittee will hold in person

meeting in November

THE “LAWSUITS”

Attorney General named 14 Golden Living facilities in complaint "Defendants' staffing practices cost residents their dignity and comfort,

and jeopardized their health and safety," the attorney general's complaint said

Defendants claim this lawsuit is the result of their suit against the AG regarding her relationship and payment of contingency fees to law firm

Philadelphia-based legal aid organization, Community Legal Services, also accused the Pennsylvania Department of Health of failing to properly investigate complaints about nursing homes or enforce regulations that are designed to protect residents' safety. DOH inspectors dismissed 92 percent of complaints from 2012

through 2014 for about 46 nursing homes that operated in Philadelphia.

It also said the department minimized the severity of violations, and never found violations in follow-up inspections

We are hearing increased scrutiny, if not at the state level than follow-up from feds

kandrisano@pacounties.org (717) 526-1010

QUESTIONS?