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					        OUTLOOK
            New York’s Comprehensive Resource for Senior Living & Community Services Providers


   The Center for Senior Living & Community Services - A division of New York Association of Homes & Services for the Aging

                                                                                                                                                           May 2006

NYAHSA Members Lobby Congress                                              CCRC Lobby Day Successful
On April 4th, NYAHSA members spent a successful day lobbying               NYAHSA held its Continuing Care Retirement Community (CCRC) Lobby Day on
lawmakers in Washington, D.C. In total, members visited with 19            May 1, with six members participating in lobbying for CCRC legislative reform.
members of New                                                             Members were briefed on NYAHSA’s reform proposal and the afternoon included
York’s congressional                                                       legislative visits with key Assembly and Senate members, including health chairs
delegation, including                                                      Senator Kemp Hannon's staff and Assemblyman Richard Gottfried. During the
meetings with                                                              visits NYAHSA submitted to legislators their updated report Continuing Care
several members of                                                         Retirement Development in New York state: A Major Economic Development
the House of                                                               Opportunity, that can be found on the NYAHSA Web site at:
Representatives and                                                        http://www.nyahsa.org.
key staff in the
offices of Senator                                                         NYAHSA is pleased that Senator Hannon has introduced legislation that amends
Clinton and Senator                                                        public health law with a variety of changes to the CCRC statute. We will continue
Schumer. The visits   [Left to Right] Kathleen Norsen, Weinberg Campus     to work with the Senate and Assembly to develop an Assembly "same-as" CCRC
                      ADHP, Sandy MacWilliam, Jane Shukitis, Don Fleter,   bill.
were conducted as
                      Unity Health Systems; Diane Darbyshire, The Center
part of the
American Association of Homes and Services for the Aging                   NYAHSA's CCRC lobby day follows an Assembly Health Committee hearing held
(AAHSA) Spring Conference and Exposition.                                  on November 22, 2005, chaired by Assemblyman Gottfried, with testimony
                                                                           presented by NYAHSA and several members. A compilation of all of the testimony
Members used the opportunity to voice concerns about the                   presented at the hearing, including NYAHSA's, can be found on NYAHSA's Web
Medicaid and Medicare cuts in the proposed budget, increasing              site at: http://www.nyahsa.org/documents.
funding for construction of affordable senior housing,
reauthorization of the Older Americans Act, increased funding for                                                                  NYAHSA has continued to advocate
social services block grants, and increasing funding for                                                                           strongly for CCRC legislative and
technology. The meetings were positive with representatives                                                                        regulatory reform. CCRCs have been
and/or their staff expressing their support of long term care.                                                                     legally recognized in New York state
                                                                                                                                   since 1989, when they were
NYAHSA wishes to thank all of those who attended these                                                                             authorized by Public Health Law
congressional visits.                                                                                                              Article 46. Life care communities
                                                                                                                                   provide unlimited continuing care, with
   Elizabeth H. Briand - NYAHSA ext. 155 - ebriand@nyahsa.org                                                                      residential, assisted living, nursing,
                                                                                                                                   dining, recreational and other services
                                                                           [Left to Right] Ken Harris, Director, The Center,       available within one setting and for
                                                                           Debbie Mcllveen,CFO, Summit at Brighton,                one monthly fee, after paying an
                                                                           Maureen Caughlin, Executive Director, Glen Arden
                                                                                                                                   entrance fee. While CCRCs are an
                                                                           Retirement Community, Carol Silver-Elliot, Executive
                                                                           Director, Summit at Brighton, Ann Wall, Director of     excellent senior housing model,
          The Center
            for Senior Living & Community Services
                                                                           Finance, Kendal at Ithaca, John Kowalik,Vice President,
                                                                           RLS, Assemblyman Richard Gottfried, Chair, Assembly
                                                                           Health Committee, Frank Mandy, Partner, New Life
                                                                                                                                   unfortunately there are just eight
                                                                                                                                   operational in New York, with just
                                                                           Management and Development                              seven more life-care and fee-for-
            A division of the New York Association
            of Homes & Services for the Aging                                                                                      service communities in pre-
                                                                           operational status. In comparison, Pennsylvania has 141 life-care communities.
                                                                           NYAHSA is also advocating for a change in Department of Insurance (DOI)
                                                                           regulations (Regulation 140, Title 11), which require operators to set excessively
  IN THIS ISSUE                                                            high entrance and monthly fees for their residents. We are pleased that DOI has
                                                                           been actively considering the association's proposed modifications of these
                                                                           regulations and has submitted recommendation to the Governor's Office of
  ASSISTED LIVING /                                                        Regulatory Reform (GORR).
  ADULT CARE FACILITIES
  Force Grapples With Affordability in                                     In addition, NYAHSA is strongly advocating to eliminate the Industrial
  Assisted Living                                                          Development Agency (IDA) sunset provision, which allows CCRCs and retirement
                                                                           communities to use tax-exempt bonds for development through the IDA. The
  HUD                                                                      authority for senior housing providers to use the IDA expires on June 30, 2006.
  Representative Kelly Supports
  HUD Programs at Hearing                                                                                  Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org


  COMMUNITY SERVICES
  Cost Report Certification Progress
                                                                                                                                                            ISSUE 3
2    OUTLOOK




                           CENTER                                                      NEWS
                                                                                                                         The Center's Regional Meetings Successful
                                                                                                                         NYAHSA convened its spring series of regional meetings specifically for
                                                                                                                         housing, subsidized housing, community services and ACF/assisted
      Parking Strategies Report Available                                                                                living members. Meetings included an overview of NYAHSA's new
                                                                                                                         Center for Senior Living and Community Services, the Quality First
      Developing and assigning parking spots can be one of the most                                                      initiative, and a legislative update. Updates on state and federal issues,
      challenging aspects of senior housing and assisted living                                                          such as the assisted living task force, Point of Entry, Nursing Home
      management. A new 61-page report entitled Parking Management                                                       Transition and Diversion Waiver, and HUD's 2007 federal budget
      Strategies: Evaluation and Planning, describes various parking                                                     sparked discussion among members. The length of the legislative
      management strategies while developing an integrated parking plan.                                                 update and subsequent discussion points to growing focus on this
                                                                                                                         aspect of continuing care. A brief presentation on best practices and
      The report refers to various policies and programs that result in more                                             innovations followed. The Center will release a Web-based Best
      efficient use of parking resources, investigates problems with current                                             Practices and Products page in the future and members are
      parking planning practices, discusses the costs of parking facilities                                              encouraged to continue to submit to this initiative. Innovations can
      and the savings that can result from improved parking management.                                                  range from simple solutions, to every day issues, to the use of new
                                                                                                                         technology.
      In addition, the report describes contingency-based planning, which
      deals with uncertainty by identifying specific responses to possible                                               NYAHSA would like to thank the staff at The Highlands at Pittsford, The
      future conditions, such as strategies that will be implemented if the                                              Oaks at Menorah Park, Woodlawn Commons, Jefferson's Ferry and St.
      current parking supply turns out to be inadequate sometime in the                                                  Margaret's House for hosting the Center's spring regional meetings.
      future. The report, published by the Victoria Transport Policy Institute,
      can be found at http://www.vtpi.org/park_man.pdf                                                                   NYAHSA welcomes feedback from members on the content of these
                                                                                                                         regional meetings, and suggestions for the fall meetings. The next
                                 Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org                                       round of The Center's regional meetings will be held in September /
                                                                                                                         October 2006.
                                                                                                                                         Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org
      Fair Housing Web Site Launched
      The Center is pleased to announce a new service offered by The
      Fair Housing Institute, Inc. (FHI). The Institute recently launched a
      new Web site that offers free access to several articles, forms and a                                                           May Is Important Month for
      newsletter relating to fair housing issues of property management,                                                              Part D Enrollment
      reasonable accommodations, accessibility, protected classes and
      court cases for housing and assisted living providers. FHI is a                                                                 For those seniors who have not already made their final
      private, full-service training and consulting company whose mission
                                                                                                                                      decision regarding Medicare Part D prescription drug
      is to educate and advise the housing industry about the economic
                                                                                                                                      benefit enrollment, it is critical that they do so as quickly as
      and social benefits of fair housing and equal opportunity.
                                                                                                                                      possible.
      Kathelene Coughlin-Williams, FHI's president, has been working in
      the field of fair housing for more than 25 years, and has presented at                                                          May 15, 2006 was the general deadline for beneficiaries to
      several NYAHSA and AAHSA conferences. Williams is also a partner                                                                sign up with a Part D prescription drug plan (PDP). Those
      in the law firm of Williams & Edelstein, P.C., providing consultation
                                                                                                                                      individuals eligible for both Medicare and Medicaid, i.e.,
      and defense representation of fair housing issues to housing
      providers throughout the country. This Web site can be found at                                                                 dual eligibles, are required to enroll in Part D and should
      http://www.fairhouse.net/index.php.                                                                                             have already been auto-enrolled. Most Medicare
                                                                                                                                      beneficiaries who are not on Medicaid have the option of
      Members will find these resources to be extremely valuable, as they
                                                                                                                                      whether or not to enroll in Part D.
      are a critical component of senior housing management.

                                                                                                                                      Although there has been some push in Congress to extend
                                 Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org
                                                                                                                                      the deadline, as of this writing it does not appear that this
                                                                                                                                      will happen and CMS is opposed to any extension. The
                                                                                                                                      deadline is important for two reasons: 1.) If the beneficiary
                                                                                                                                      does not enroll by the deadline, they will have to wait until
                                OUTLOOK                                                                                               the next open enrollment period; 2.) There is a premium
     Carl S. Young . . . . . . . . . . . . . . . . .NYAHSA President                   ABOUT The CENTER                               penalty for each month that the individual did not have
                                                                                                                                      creditable coverage and was not enrolled in Part D. The
     Dan Heim . . . . . . . . . . .Vice President for Public Policy
                                                                                       The Center for Senior Living and               next open enrollment period is set for November 15
     Peggy Morache . . . . . . . . . .Associate Vice President for                     Community Services is a team                   through December 31 of 2006. The premium penalty is
                                                Member Services
                                                                                       approach to meeting the changing               calculated as 1 percent additional premium for each month
     Ken Harris . . . . . . . . .Director of The Center for Senior                     needs of NYAHSA members who                    in which the individual did not have creditable coverage for
                                    Living & Community Services
                                                                                       provide senior housing, assisted living        any continuous period of 63 days or more after the end of
     Diane Darbyshire . . . .Policy Analyst for Assisted Living                        and community-based services.                  their initial enrollment period. Any beneficiary who wants
                                      & Community Services                                                                            to enroll in Part D but has yet to do so should act as soon
     OUTLOOK
                                                                                                                                      as possible.
     published monthly by The Center for
     Senior Living & Community Services
     150 State Street
                                                                                       ABOUT NYAHSA                                   There are special enrollment periods (SEPs) that may
     Albany, NY 12207                                                                                                                 apply. CMS has just announced that beneficiaries who are
     Telephone: (518) 449-2707                                                         Founded in 1961, NYAHSA represents
                                                                                                                                      not dual-eligibles but qualify for the low-income subsidy
     Main Fax: (518) 455-8908                                                          nearly 650 not-for-profit, public and
                                                                                                                                      (LIS) under the new Medicare prescription drug program
                                                                                       mission-driven providers, including
     Erin Silk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Editor                                                  can sign up for the subsidy and enroll in a drug plan
     esilk@nyahsa.org s (518) 449-2707, ext. 157                                       nursing homes, senior housing, adult
                                                                                                                                      beyond the May 15 deadline. This special enrollment
                                                                                       care facilities, continuing care retire-
     The acceptance of a product, service or company as an                                                                            period will also apply to beneficiaries who were enrolled in
     advertiser or manuscript for publication does not imply                           ment communities, assisted living,
                                                                                                                                      a prescription drug plan through a state pharmaceutical
     endorsement or approval of the product, service, company or                       community services providers and
     opinion.
                                                                                       managed long term care programs.                                             ❑ See May is Important Month page 4

    MAY   2006                                                                                                                                                                          www.nyahsa.org
                                                                                                                                                          OUTLOOK       3



       ON THE
                     HUD                       FRONT
                                                                                           AAHSA's Affordable Housing Cabinet
                                                                                           Meeting Convened
                                                                                           On April 4, AAHSA's Affordable Housing Finance Cabinet held its
      AAHSA Conference Provides HUD Updates                                                fourth meeting in Washington D.C. The Cabinet is charged with
                                                                                           identifying short term and long term goals in defining new financing
      At the American Association of Homes and Services for the Aging (AAHSA)              models and administrative / regulatory reforms that will be
      Future of Aging Services conference in April, several sessions provided
                                                                                           necessary to increase the supply of affordable senior housing with
      updates on federal housing policy and the U.S. Department of Housing and
                                                                                           services in the future.
      Urban Renewal (HUD) programs and budget.

      Hank Williams, Deputy Assistant Secretary of the Office of Affordable Housing        The Cabinet is co-chaired by AAHSA Chair Elect and NCR CEO
      Preservation (OAHP), was the keynote speaker at the HUD sessions. Mr.                Tom Slemmer and Lancaster Pollard Director, Brian Pollard. Cabinet
      Williams has direct oversight over all senior housing and disability projects, and   members include AAHSA staff, the past Deputy Assistant Secretary
      recently succeeded Stillman Knight in this position.                                 of HUD's Multi-Family Housing, Stillman Knight, NYAHSA's Center
                                                                                           Director Ken Harris as the AAHSA state affiliate representative, and
      Williams informed members that the Section 202 PRAC properties would not             leaders in senior housing finance.
      be taken over by the state contract administrators because HUD offices have
      been awarded contracts through the 876 Process. PRAC and 236 projects will
                                                                                           The meeting began with a discussion regarding Section 202
      receive their contract administration through newly developed regional offices.
      For New York those offices will be located in Boston and Philadelphia. It is         preservation and reform, including the cap on seller secondary
      unclear if state HUD staff will be required to move to these new locations.          financing, developer fees, application processing, tax credit
                                                                                           problems and use agreements.
      Williams noted that a new report will be issued by HUD stressing the
      importance of housing and services within the Section 202 program. Such              Cabinet member Nancy Eldridge and Amy Wright, Cathedral
      services allow seniors to stay in supportive housing longer, delaying or             Square Corporation (CSC), and Sarah Carpenter, Vermont Housing
      preventing most costly placements. Williams also noted that the report found
                                                                                           Finance Agency, gave a presentation on a mixed-finance deal they
      that the Section 202 program is under-funded by an average of 20 percent
                                                                                           have recently completed in Burlington, Vermont. The project
      nationwide, and in states such as New York this number would be even higher.
      Yet, Williams said, that because it was proposed that HUD receive less funds         combined a Section 202 capital advance for 42 units and tax credits
      than previous years, increasing the funds allocated per project would further        for all 63 units. The Vermont HFA has closed one prior mixed
      decrease the number of Section 202 apartments built each year.                       finance deal and has another in the works. Using Section 202 and
                                                                                           Low Income Housing Tax Credits to leverage funding for affordable
      Williams admitted that there were bottlenecks in HUD's decision-making               housing is just starting to be processed by HUD with only three
      process, including approvals of refinancing senior housing projects. There are       projects of this type completed across the country. CSC embarked
      only 100 employees at HUD Headquarters in Washington and 1,700
                                                                                           on this deal in part in response to a new Vermont Medicaid waiver
      employees in local offices. HUD is attempting to shift decisions to the local
                                                                                           allowing recipients to choose whether they receive services in a
      level to improve efficiency.
                                                                                           nursing home or in the community. (Eldridge will present on this
      Ken Harris, NYAHSA's Director of Senior Living and Community Services,               topic at NYAHSA's Spring Institute at the session Nursing Home-
      spoke to Assistant Secretary Williams about housing and services and how             Level Care in Senior Housing.)
      HUD's Assisted Living Conversion Program (ALCP) is underutilized due to the
      requirement of facilities to acquire a state assisted living license. Harris noted   Hank Williams, Deputy Assistant Secretary of the Office of
      that the program would be much more effective if facilities could use ALCP           Affordable Housing Preservation (OAHP), and John Garvin, new
      funds to build health centers and for building modifications while contracting
                                                                                           senior advisor to Brian Montgomery, Assistant Secretary of
      with home health agencies and clinics to bring licensed services into the
                                                                                           Housing/Federal Housing Commissioner joined the meeting and
      facility. Williams was receptive to learn more about the idea, and NYAHSA will
      work with members and AAHSA to develop a proposal.                                   discussed HUD initiates with housing finance and preservation.

      The second HUD Update session panel included Kathy Coughlin-Williams, a              The next meeting of AAHSA's Affordable Housing Finance Cabinet
      fair housing attorney based in Atlanta, and Candi Atkins, management                 will be held at the AAHSA Leadership Summit in Baltimore, MD,
      consultant and administrator. The topic of this presentation was the new HUD         July 27-28.
      Management and Occupancy Review (MOR) and fair housing concerns.                                     Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org
      Coughlin-Williams reviewed the new HUD 9834 MOR form, including the new
      fair housing audit, highlighting the problems that administrators should
      anticipate and the appropriate role of the contract administration staff in
      conducting the review. Williams reviewed the form's "accessible unit" section
      where apartments counted as handicapped units must comply with Uniform               Representative Kelly Supports HUD
      Federal Accessibility Standards (UFAS) at the time of construction. A quick
      test for UFAS compliance is a 32-inch door "clear space" opening for all
                                                                                           Programs at Hearing
      apartment doors.
                                                                                           On March 30 at a Congressional hearing before the House
      Williams noted the HUD form 9834 Addendum B, Part B, includes the Fair               Financial Services Committee, Representative Sue Kelly (R-19,
      Housing plan that must be approved by HUD's Fair Housing and Equal                   Fishkill / Goshen) told HUD Secretary Alphonso Jackson that the
      Opportunity (FHEO) office. While this form approval is often delayed for several     proposed funding cuts to the Section 202 housing program for the
      months, Williams suggests that property managers send the form "Return               elderly and the Community Development Block Grant (CDBG)
      Receipt Requested" and keep the receipt in the property's Fair Housing file for
                                                                                           program were unacceptable. Representative Kelly stated that the
      proof of submission during a MOR inspection.
                                                                                           need for these programs is great and funding for senior housing
      During the third session, Terry Allton, Director of Social Services at National      and service programs should be increased not reduced.
      Church Residences (NCR), recounted the work of NCR and AAHSA in
      establishing the disaster hotline for seniors in the impacted areas of hurricane     President Bush recently proposed cutting $190 million, which
      Katrina. NCR Service Coordinators staffed the phone lines and placed 55              represents a 25 percent reduction of the total budget, from the
      seniors in permanent housing in other parts of the country, including HUD            federal Section 202 program that provides for both construction and
      facilities in New York state. Allton screened a DVD that NCR produced about          rent subsidies for low-income elderly. The remaining funds would
      their experience, recounting the problems and challenges of starting a disaster
                                                                                           provide an average of 54 new apartments per state, or about one
      plan from scratch in the days following the hurricane. NYAHSA would like to
                                                                                           apartment complex.
      commend NCR and AAHSA for their valiant work during this disaster.
                                                                                                                           ❑ See Representative Kelly Supports page 6
                               Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org

MAY   2006                                                                                                                                            www.nyahsa.org
4    OUTLOOK



    Emergency Preparedness
    Resources Available
                                                                                                       TECHNOLOGY CORNER
    On September 11, 2001, Joe Breed, Executive Director of St.
    Margaret's House (SMH) was meeting with three visiting engineers
    when a large boom rocked the building. Breed quickly determined that
    the problem was not within SMH, but outside. St. Margaret's House, a                       The following in an excerpt from The Washington Post - April 17, 2006
    20-floor, 251 apartment complex, was 900 yards from the site of the                        Slew of Gadgets Helps Tackle Small Tasks
    worst terrorist attack against the United States. The morning's events                     Occupational Therapists Advise Seniors on Ways to Ease
    unfolded powerfully as Breed and his staff members struggled with a                        Independent Living
    new meaning of the word "disaster."                                                        By Michael Alison Chandler

    Needless to say, this was no time for Breed to create an emergency                         Although technology fairs showcase "smart" houses of the future —
    plan that would ensure the safety of his residents. Fortunately, SMH                       with robot vacuums and talking microwaves — for the 80 million baby
    had developed and practiced an extensive emergency plan prior to the                       boomers reaching retirement age, lots of low-tech and relatively
    disaster. The plan was implemented immediately, providing safety, and                      inexpensive innovations can help seniors live independently now.
    possibly saving the lives of SMH residents and others involved in the
    terrorist attack.                                                                          There are nail clippers with magnifying lenses for those with dimming
                                                                                               vision, long-handled hairbrushes helpful for someone with an arthritic
    As the scope of potential disasters has broadened in recent years to                       shoulder, telephones that ring loudly and flash a red light for the hard
    include terrorist attacks, hurricanes and Avian Flu, properly developing                   of hearing, and forks and spoons with heavier handles designed to
    and updating disaster plans for senior housing and assisted living                         steady hands shaking because of Parkinson's disease or other
    communities matters more than ever. The time to learn what to do in a                      neurological disorders.
    disaster is before it ever happens.
                                                                                               For those struggling with short-term memory loss, an automatic pill
    AAHSA has developed, along with NYAHSA member Joe Breed, a 61-                             dispenser beeps when it's time to take medication. And for someone
    page technical assistance paper entitled, Updating Your Disaster Plan.                     with advanced dementia, posters meant to disguise doors as
    The paper provides a detailed description how to prepare for a disaster,                   bookshelves can prevent wandering.
    including what to do before, during and after a disaster strikes.
                                                                                               Many of these objects cost less than $100 — some of them much
    AAHSA / NYAHSA members can find this and other disaster                                    less — and can be found on such Web sites as www.abledata.com
    preparedness resources on the AAHSA Web site at: www.aahsa.org.                            and www.senioremporium.com/ or in catalogues available through
    (Go to the left side of the Web page under "Publications and                               agencies on aging.
    Resources".) On this page a number of other emergency preparedness
    resources are also available, including specific information for
    subsidized housing, market rate / CCRC, and assisted living facilities.

                      Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org




    May is Important Month from Page 2

    assistance program (SPAP), allowing these individuals to make one change to a different plan before the end of 2006. For New York, the SPAP is
    the Elderly Pharmaceutical Insurance Coverage (EPIC) program. These changes affect beneficiaries who do not live in nursing homes. Dual
    eligible nursing home residents may change plans on admission and once a month after that. In addition, EPIC is considered creditable coverage
    and therefore would allow the beneficiary to avoid the late enrollment penalty.

    The SEP for individuals who qualify for the LIS is designed to facilitate on an ongoing basis enrollment of LIS eligible individuals who have not
                                 .
    proactively enrolled in a PDP The current guidance specifies that CMS will facilitate enrollment in a PDP effective May 1, 2006 for individuals that:
    1.) Qualify for LIS because they receive Supplemental Security Income (SSI) benefits; or 2.) Receive help from their state in paying their Medicare
    premium, i.e., the beneficiary is part of a Medicare Savings Program (MSP).


    CMS believes it is important to give these individuals who qualify for the LIS the immediate opportunity to be enrolled in a plan and make use of
    this assistance. Therefore, this additional SEP will allow the individual to choose a PDP on his/her own. If no choice is made, CMS will facilitate
                             .
    the enrollment into a PDP If CMS facilitates the enrollment, the beneficiary will have an SEP to change plans. The SEP will begin upon notification
    to the individual of his/her LIS status or the effective date of facilitated enrollment (whichever occurs first), and ends either when the individual
                                                                      .
    enrolls in a PDP or upon CMS facilitation of enrollment into a PDP Proof of eligibility for this SEP may include the subsidy award letter from SSA
    or the state, or a notice from CMS informing the beneficiary that he/she has been deemed eligible for the subsidy and enrolled in a plan. The
    effective date for this SEP will be either the effective date of the facilitated enrollment, or, if the beneficiary makes a choice, the first day of the
    month following receipt of the enrollment request by the PDP.


    The facilitated enrollment is essentially the same as the auto-enrollment that occurred with dual eligibles late last year. In other words, this new
    SEP for the LIS/MSP eligible beneficiaries creates an SEP option analogous to the dual eligibles who were auto-enrolled and then are allowed the
    option to change the PDP assignment.


                                                                                                Patrick Cucinelli - NYAHSA ext. 146 - pcucinelli@nyahsa.org




    MAY   2006                                                                                                                                                 www.nyahsa.org
                                                                                                                                                    OUTLOOK      5




                 WHAT ’S NEW?
                         ... IN ASSISTED LIVING             & ADULT CARE FACILITIES


  2006 Assisted Living Week Theme                                              Task Force Grapples With Affordability in
  Announced                                                                    Assisted Living

  This year, AAHSA's assisted living members will celebrate "Hearts in         The Adult Care Facilities (ACFs) and Assisted Living Residences (ALRs)
  Harmony" as part of the 12th annual National Assisted Living Week            Task Force continues to struggle with how to make the ALR affordable
  (NALW) celebration, Sept. 10-16, 2006. Organizers chose this year's          and accessible to low income individuals. At the April 26 meeting, the
  NALW theme to recognize the shared desire of residents, family               group was briefed on the Nursing Home Transition and Diversion Waiver,
  members, staff and leaders for older adults to receive quality that they     Long Term Care Restructuring Initiative, and the Medicaid payment
  can trust. AAHSA's assisted living members will soon receive a guide to      system in the Assisted Living Program (ALP). These presentations were
  help them plan their organization's NALW celebration. For more               arranged to inform task force members about other continuing care
  information, contact Doug Pace, (202) 508-9454.                              initiatives in the state, and to consider how they might assist in making
                                                                               the ALR affordable.
                     American Association of Homes & Services for the Aging
                                                                               Following the presentations, the task force discussed affordability in the
                                                                               ALR. It was recommended that the requirements of the three levels of

  Pending ALP Projects Soon to be                                              the ALR be costed out, making discussion of affordability issues easier.

  Operational                                                                  Additional information was requested of the Department of Health (DOH)
                                                                                                                                       ,
                                                                               regarding personal care and home care financing, the ALP and the

  NYAHSA recently attended a meeting with the Department of Health in          Limited Licensed Home Care Services Agency. The task force is also

  which it was reported that several Assisted Living Program (ALP)             considering asking representatives from housing, such as the Department

  approved projects are close to being operational. A 40-bed ALP in Kings      of Housing and Urban Development (HUD) and the New York State

  County should open soon, and a 52-bed ALP in Chautauqua is expected          Division of Housing and Community Renewal (DHCR) to look at

  to open in the fall. In addition, a 200-bed program in Suffolk County will   affordability in assisted living from the housing perspective.

  be starting construction soon.
                                                                               NYAHSA provided public comment at the end of meeting, again raising

  The ALP which began in New York in the early 1990s, is a Medicaid
         ,                                                                     concern about the nurse staffing requirements in the Enhanced ALR and

  funded assisted living program designed to retain individuals in Adult       the Special Needs ALR, and the expense of the model being developed.

  Care Facilities (ACFs) who would have otherwise required nursing home        NYAHSA reinforced the importance of looking at the costs of the

  placement. The program is capped at 4,200 beds statewide, which              requirements, to determine if the model will be viable from a consumer or

  NYAHSA believes is insufficient to meet the needs of low income New          state funding perspective. This discussion is essential to ensure that the

  Yorkers.                                                                     ALR does not, in actuality, promote nursing home placement. NYAHSA
                                                                               voiced concerns about a shift from the historic social model of the ACF to

  The ALP is a complicated program to open and operate. Operators must         a more medicine-focused ALR, and the impact on quality of life for

  adhere to three different sets of regulations, and the pre-opening process   residents. Lastly, NYAHSA again advocated for flexibility in achieving

  with the state and local entities is very involved. For these reasons, the   staffing levels, such as the preservation of the adult home regulation that

  time between approval and operational stages can be significant.             allows a nursing home administrator in a multilevel facility to also serve as

  NYAHSA is pleased to see that these approved programs will soon be           the adult home administrator.

  operational, and continues to advocate for the expansion of the ALP.
                                                                               It was determined that the affordability discussions and medication issues
                                                                               will be on the agenda for the next meeting, scheduled for May 23. In
              Diane Darbyshire - NYAHSA ext. 162 - ddarbyshire@nyahsa.org
                                                                               addition, an estimated timeframe for completing the task force's work will
                                                                               be discussed.


                                                                                         Diane Darbyshire - NYAHSA ext. 162 - ddarbyshire@nyahsa.org
             22-25
             MAY




MAY   2006                                                                                                                                      www.nyahsa.org
6    OUTLOOK



                                                                                                    2006 AAHSA Leadership Summit
                                CALENDAR                                                            Mark your Calendars for the 2006 AAHSA Leadership
                                                                                                    Summit – Primal Leadership: Learning to Lead with
          M AY                                                                                      Emotional Intelligence, with best-selling author Richard
                                                                                                    Boyatzis.
          5/22-25       NYAHSA’s 2006 Spring Institute & Training Exhibition
                        Saratoga Springs, NY                                                        Building on last year's amazing opportunity with Jim
                                                                                                    Collins, we invite you to unleash the power of
          5/22          NYAHSA-PAC Spring Invitational Golf Tournament                              emotional intelligence in yourself…and your
                                                                                                    organization! Bring your top management and trustees
                                                                                                    to the 2006 AAHSA Leadership Summit, July 27-28 in
          J U N E                                                                                   Baltimore, Md., to explore and apply the principles of
                                                                                                    emotional intelligence. Specifically for chief executives,
          6/7           Legislative Update conference call                                          trustees and senior management, this highly
                                                                                                    interactive two-day event gives you an exclusive
          6/12-13       NYS Department of Health Dementia Conference. Albany, NY
                                                                                                    opportunity to learn directly from the author of one of
          6/19          Legislative Update conference call                                          the most sought after leadership books ever written.
                                                                                                    For more information, visit www.aahsa.org.
          6/22-23       CCRC Summer Summit
                                                                                                            Essie Charles, American Association of Homes
                                                                                                                                and Services for the Aging
          J U LY
          7/27-28       2006 AAHSA Leadership Summit




    Educational Teleconference Series Concludes with
    Mega Waiver and POE Sessions                                                                   Are you looking for a job?
                                                                                                 Have a position you need to fill?
    NYAHSA recently concluded the continuing care reform educational teleconference
    series, which provided updates and answered member questions regarding various                        Two words:

                                                                                                      JOB MART
    initiatives and reform efforts underway in the state.

    Neal Lane, Director of the New York State Office for the Aging, presented on the
    Point of Entry (POE) Initiative. According to Mr. Lane, the state is moving forward           The Center’s JOB MART can help match
    with the first phase of POE, which involves the creation of local, county based                  future employers with job seekers.
    resource centers to provide comprehensive, unbiased information on long term care
    services. It is expected that this aspect of the project will be implemented in fall or
                                                                                                            E-mail esilk@nyahsa.org
    winter of this year. The second phase of POE is projected to be approximately three
    or four years from implementation. This aspect of the project would involve an
                                                                                                              for more information.
    assessment piece for individuals bound for long term placement in a nursing home.
    All publicly funded individuals would also go through the POE.

    Bob Sherman and Steve Fisher of the DOH Long Term Care Restructuring Initiative
    presented on the Mega Waiver. New York plans to apply to the Centers for Medicaid
    and Medicare (CMS) for an 1115 waiver, also termed the "Mega Waiver". Essentially,         Representative Kelly Supports from Page 3
    this would involve folding all long term care state plan and waiver services into one
    waiver. It is expected that this would be implemented in tandem with phase two of          AAHSA has developed a Grassroots Toolkit with several
    the POE. Many of the questions pertinent to NYAHSA members are currently under             resources to advocate against the budget cuts and in favor of
    careful consideration.                                                                     an increase in subsidized housing and services programs.
                                                                                               AAHSA / NYAHSA members can go to the AAHSA Website
    Regional meetings for the restructuring initiative, which Mr. Sherman, Mr. Fisher, and     at www.aahsa.org, and go to the left side of the Web page
    colleagues are leading, are winding down. It was noted that housing, transportation        under "Advocacy, Policy and Government". Resources
    and workforce issues have been raised in every regional meeting as major concerns          include:
    and considerations in moving forward with this project. The last meeting, which
    requires registration, is scheduled for May 31 in Uniondale. Mr. Sherman and Mr.           • Talking points;
    Fisher stressed in their presentation their desire to hear from members, in the            • Contact Congress;
    context of regional meetings, through a Request For Information, or by contacting          • Senior Housing Story Sheet;
    the staff directly. They are particularly interested in hearing about best practices and   • Budget Charts; and
    innovative programs that providers are already using. NYAHSA encourages                    • Sample letter and petitions.
    members to provide input both through NYAHSA and directly to initiative staff.
                                                                                               Congress needs to hear that these budget cuts work against
    NYAHSA would like to thank Bruce Rosen, Director of the Nursing Home Transition            policies that encourage consumers to remain in supportive
    and Diversion Waiver (NHTD), as well as Neal Lane, Bob Sherman, and Steve                  housing as long as possible. NYAHSA encourages members
    Fisher for their presentations and open dialogue with NYAHSA. Presentations on             to use the AAHSA resources to contact Congress and
    the NHTD, POE, Mega Waiver, and Commission on Health Care Facilities in the 21st           advocate for these programs because we are at a critical
    Century will take place at Spring Institute on May 23rd.                                   time of policy development.

                       Diane Darbyshire - NYAHSA ext. 162 - ddarbyshire@nyahsa.org                   Ken Harris - NYAHSA ext. 139 - kharris@nyahsa.org


    MAY   2006                                                                                                                                  www.nyahsa.org
                                                                                                                                                            OUTLOOK      7




                       WHAT ’S NEW?
                                                       ... IN COMMUNITY            SERVICES


  MedPAC Home Care Recommendations                                                Revised Home Care Curriculum Released
  Include Additional Payment Freeze
                                                                                  The Department of Health (DOH) has announced the revised home
  Despite a payment freeze already imposed on home health agencies                health aide training curriculum. The Dear Administrator Letter and
  (HHA) for calendar year (CY) 2006, the Medicare Payment Advisory                following revised documents are posted on the Health Provider Network
  Commission (MedPAC) is recommending extending the rate freeze to                (HPN):
  2007.
                                                                                  • Home Care Curriculum
                                                                                  • Health Related Tasks Curriculum
  MedPAC is an independent federal body established by the Balanced
                                                                                  • Home Care Curriculum evaluations
                       .L.
  Budget Act of 1997 (P 105-33) to advise the U.S. Congress on issues
                                                                                  • Health Related Tasks Curriculum evaluations
  affecting the Medicare program. While MedPAC's recommendations are
                                                                                  • Home Health Aide Scope of Tasks
  not binding on Congress, they are considered and represent an important
                                                                                  • HHATP Facility List; and
  indicator of the federal government's current thinking and potential policy
                                                                                  • Frequently Asked Questions (FAQs).
  direction for the coming year. The March 2006 MedPAC annual report to
  Congress may be accessed on their Web site at www.medpac.gov.
                                                                                  The home health training programs, which are approved by DOH every
                                                                                  three years, must incorporate this revised material into their training
  The report's main recommendation is to eliminate the update to payment
                                                                                  programs by October 1 of this year.
  rates for CY2007. MedPAC's rationale for this recommendation is based
  on their analysis that access to care is good, margins are adequate, and
                                                                                              Diane Darbyshire - NYAHSA ext. 162 - ddarbyshire@nyahsa.org
  cost are not rising significantly. The analysis cites a 16.0 percent margin
  for 2004 and a projected margin of 14.7 percent for 2006, with only a 0.6
  percent average increase in costs. The federal Deficit Reduction Act of
  2005 (DRA) eliminated the trend factor increase for CY2006. Without
                                                                                  Long Term Care Issues in the Deficit
  another trend factor freeze, HHAs are projected to receive a 3.4 percent
                                                                                  Reduction Act
  market basket increase (MBI) for CY2007.

                                                                                  The Kaiser Family Foundation has issued five new reports on the long
  NYAHSA continues to stress, however, that this narrow focus on the              term care-related provisions of the federal Deficit Reduction Act of 2005
  Medicare payment rate misses the fact that whatever margin exists on            (DRA). The DRA, which became law this February, includes several
  the Medicare side is consumed by the loss incurred in Medicaid. HHA             changes to Medicaid policies for long term care. The reports, which can
  Medicare payments are established by a statutory formula that includes          be viewed at: http://www.kff.org/medicaid/kcmu041706pkg.cfm, are
  provision for cost increases as measured by the MBI. NYAHSA has                 entitled:
  serious concern that losses on the Medicaid side combined with a                • Medicaid Long Term Services Reforms in the Deficit Reduction Act
  Medicare rate that fails to keep up with inflation will cause serious harm      • Asset Transfer and Nursing Home Use: Empirical Evidence and
  to the financial viability of our state's HHAs.                                  Policy Significance
                                                                                  • Beyond Cash and Counseling: An Inventory of Individual Budget-based
  Interestingly, the study also cites advances in telehealth technology as         Community Long Term Care Programs
  another justification for limiting cost increases to HHAs. MedPAC               • Nursing Home Transition Programs: Perspectives of State
  believes that the greater efficiency achieved through telehealth                 Medicaid Officials; and
      initiatives will provide its own financial return and therefore there is    • Home Transition Programs: Perspectives of Medicaid Care Planners
  no need to recognize the home health agencies' cost of investment in
  technology. NYAHSA cautions that it is much to soon to draw                                 Diane Darbyshire - NYAHSA ext. 162 - ddarbyshire@nyahsa.org
  that conclusion, and, in fact, most agencies heading in this direction
  will likely experience significant start-up costs and learning curve issues
  before seeing any significant cost savings. Telehealth initiatives do hold
  significant promise to both increase efficiency and the quality of care/life    Cost Report Certification Progress
  of home care recipients. Telehealth, however, represents an important
  investment in the future of home care services and reimbursement                A year after the issue first surfaced, the Department of Health (DOH) and
                                                                                  the New York State Society of Certified Public Accountants (NYSSCPA)
  based upon good public policy should be encouraging this investment.
                                                                                  have reached agreement on the revised independent auditor's certification
                                                                                  that nursing homes file as part of their Medicaid cost report. This also
                    Patrick Cucinelli - NYAHSA ext. 146 - pcucinelli@nyahsa.org   brings resolution for other providers a step closer.

                                                                                  In mid-April, DOH sent nursing homes a copy of the new revised auditor's
                                                                                  certification form to be used to certify 2004 cost reports. It was
                                                                                  accompanied by a letter stating that homes must have a signed copy of
                                                                                  either the new certification form or the certification form provided with the

                                                                                                                              ❑ See Cost Report Certification page 8



MAY   2006                                                                                                                                              www.nyahsa.org
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   8
           The Center
              for Senior Living & Community Services
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   OUTLOOK



              A division of the New York Association
              of Homes & Services for the Aging
              150 State Street, Suite 301
              Albany, NY 12207-1698
              Telephone: (518) 449-2707
              Fax: (518) 449-8210
              Web: www.nyahsa.org




                                                                                                                                                                                                                                                             unwilling to sign the revised certification.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Cost Report Certification from Page 7


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         May 1 and included the revised certification form.




OUTLOOK
A publication of The Center for Senior Living & Community Services
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    without a 2004 certification on file will need to submit within 30 days.




                Spring Institute 2006 Shaping the Future Promotion
          Refer a friend...save $50! Bring a first-time attendee from the field of
                senior housing, assisted living, CCRCs or home and community based
                services to NYAHSA’s Spring Institute and deduct $50 from the cost of
              your registration. Bring as many new attendees as you like and take off $50
                       for each one up to the maximum cost of a full registration!
                                                                                                                                                                                                                                                                                                                                                                                                                   deadline for CHHAs and LTHHCPs once final agreement on the certification form for these providers is achieved.




                                         Don’t wait – register to attend today!
                                             Fax FLTC at 518-434-4385
 For the purposes of this promotion, a new attendee is anyone who has never attended NYAHSA’s Spring Institute or who has not attended in the past five years. Any NYAHSA member is eligible
 for the discount, but the $50 discount may be taken only for new attendees from the member categories of assisted living, market rate or subsidized senior housing, CCRCs, and home and
 community based services. The $50 discount will be given to the maximum of $625 for full registration. The NYAHSA member taking the discount must be registered for the full conference.
 The referral registrations must be sent along with the registration of the NYAHSA member who is taking the discount and must include a brief note referring to the Shaping the Future discount
                                                                                                                                                                                                                                                                                                                                                                                                                   based RHCF-2 filers are still required to file by the May 30 deadline. It is not yet clear whether DOH will extend the 2005 cost report filing




 promotion. The first time attendees must actually attend the conference. If a NYAHSA member takes a discount for a referral, and the referral subsequently does not attend the conference,
                                                                                                                                                                                                                                                                                                                                                                                                                   In response to NYAHSA's timeframe concerns, DOH has extended the filing deadline for 2005 RHCF-4 filers to June 30, although hospital-




                                                                                                                                                                                                                                                             Despite these positive developments, the issue is not fully resolved even for nursing homes. Regardless of the DOH-NYSSCPA agreement,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    few weeks. It is expected that the letter will be accompanied by the revised home care cost report certification which CHHAs and LTHHCPs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    According to DOH, revised language for the Certified Home Health Agency (CHHA) and Long Term Home Health Care Program (LTHHCP)




 requests a refund and is eligible for a refund, the NYAHSA member who took the discount will be billed and will be expected to reimburse NYAHSA for the amount of the refund.
                                                                                                                                                                                                                                                             some accounting firms, specifically the large national firms, continue to express concerns about the revised certification language and may be
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Medicaid cost report auditor's certification is nearing completion. They anticipate issuing a similar letter as was sent to nursing homes within a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         2004 RHCF software on file by June 2, 2006. Failure to do so will result in penalties. The 2005 nursing home cost report software was posted on




                                                                                                                                                                                                                                                             reluctant to sign even the revised certification forms. Providers are urged to speak with their auditors and to let NYAHSA know if their auditor is



                                                                                                                                                                                                  Darius Kirstein - NYAHSA ext. 104 - dkirstein@nyahsa.org

				
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