HCAM/MCAL Year End Report

Health Care Association of Michigan & Michigan Center for Assisted Living 2018 Annual Association Report Medicaid Cost Report Audit Improvements Highlight 2018 Achievements In February 2014, the Health Care Association of Michigan, at the request of the Director of the Michigan Department of Community Health, presented a “Medicaid Process Reform” document to the department that identified several inefficiencies in the reimbursement process and proposed solutions. In 2018, HCAM worked with Senators Pete MacGregor, Jim Stamas, and Goeff Hansen to address these issues legislatively.

Senate Bill 1038 (Senator Stamas) was passed by the legislature and approved by Governor Snyder on December 28. Completion of the legislation is the culmination of a year-long effort between HCAM staff and consultants, members, bill sponsor and the Michigan Department of Health and Human Services (MDHHS). The bill improves the audit system to be more timely, fair, and efficient. Upon receiving Governor Snyder’s signature, SB 1038 was assigned Public Act 612 of 2018, and will take effect in late June of 2019.

Also signed by the governor was SB 601 – the supplemental appropriations bill. Contained in the bill, which is Public Act 618 of 2018, was an update to the current asset value (CAV) bed limit. The boilerplate language will result in a significant increase to the CAV limit for providers beginning in fiscal year 2020. You can find more information on the legislation on page 7.

Board members and staff met with then candidate Gretchen Whitmer at Wellbridge of Novi.

Targeted Campaign Donations Position Association for the Future During the 2018 campaign season, the association participated in numerous fundraisers and supported candidates on both sides of the aisle. Tours of member facilities were held to help candidates understand our issues and meet our staff and residents. This plan helped to position the association to move quickly in 2019 with the new administration and legislature.

70 Years of Service 2018 saw the Health Care Association of Michigan celebrate its 70th anniversary. In 1948, a handful of providers came together and formed the Michigan Association of Approved Nursing Homes – the predecessor to HCAM. In those early years the providers were typically families who took in the community’s aging seniors to offer care in their personal homes or converted houses. As the profession evolved through the years, the association has as well. In 1999, we formed the Michigan Center for Assisted Living – a division of HCAM. Today, we represent several options for our seniors as their care needs change, and we are proud to report the association is stronger than ever. HCAM represents 345 nursing facilities – nearly 80 percent of the nursing facility beds in the state and through the Michigan Center for Assisted Living we represent more than 145 assisted living communities.

Quite a bit has changed since those early days, but not the PURPOSE of what you do – the purpose of caring for our elderly when they can’t any longer – and today, 70 years later you are providing amazing care in beautiful facilities throughout the state!

Let us say THANK YOU! And though your purpose hasn’t changed - the world in which we operate has changed dramatically.

Our reimbursement system has changed, regulations have increased, and the acuity of our residents has most certainly changed. And change continues – at what times feels like a frantic pace…from Payroll Based Journal, to the Requirements of Participation, to managed care and now we are on the verge of the Patient Driven Payment Model!

And the 2018 election brought a sea change in our state government structure as well. We will build on our relationship with Governor Gretchen Whitmer and develop relationships with Attorney General Dana Nessel and new members of the State House of Representatives and Senate.

Just as your purpose hasn’t changed over the decades - our purpose as an association has not either...we are here to serve you through strong educational programming, expertise in reimbursement and regulation and strong advocacy on behalf of the members we represent.

Despite the significant challenges you are facing we are optimistic for the future – together we will help you succeed…we will help you fulfill your PURPOSE. We are grateful for the trust you have placed in us. The HCAM/MCAL team remains energized and ready to meet your needs in 2019!

The 2018 Year-End Report details the major issues we have worked on over the past year - including provisions of our annual strategic plan.

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Reimbursement/ Managed Care Advocating Against the Implementation of Managed Care HCAM has conducted extensive research to gather information on the impacts of managed care for long-term care. Through research and discussions with several state affiliates, there is mounting evidence that managed long-term care support and services (MLTSS) does not achieve the desired goals of cost savings and coordination of care. HCAM is working to complete a white paper detailing these deficiencies. HCAM also helped to convene a coalition of long-term care providers, including the Area Agency on Aging Association of Michigan (4 A), Michigan Home and Community Services Network, County Medical Care Facility Council and Leading Age Michigan, to advocate against the implementation of MLTSS. In fiscal year 2017, the Michigan Association of Health Plans was successful incorporating language into the budget requiring MDHHS to explore MLTSS. In fiscal year 2018, there was an attempt made to expand this mandate to explore the structure and timeline of implementation, along with costs broken down by fund source and identifying obstacles to implementation of MLTSS. Though HCAM and others were successful in advocating for the removal of the new language, it is expected discussions are likely to continue on this issue in 2019.

MI Health Link – Michigan’s Duels Demonstration Project Michigan Medicaid has operated an integrated care duals pilot since 2015 called MI Health Link (MHL). MHL is in four regions of the state ranging from the entire Upper Peninsula to specific counties in both south west and south east Michigan, and enrollment is voluntary. The program integrates the services and funding streams from both the Medicare and Medicaid programs under a managed care health plan arrangement called Integrated Care Organization (ICO). Since the inception of MHL less than 2,000 individuals residing in nursing facilities have participated in the MHL ICO’s. As in the initial years, the ongoing operation concerns continued primarily regarding timely and accurate payments for services. MDHHS has been exploring the expansion of this program or something similar to enroll all duals in managed care plans. The experience with MHL has not been positive for nursing facility residents or nursing facility providers. The claims of savings and better coordination of care have not materialized. In 2019 HCAM will be fully engaged with MDHHS to not move forward on any expansion of managed care for dual eligible individuals.

Quality Measure Initiative The Michigan Department of Health and Human Services (MDHHS) Medicaid Quality Measure Initiative (QMI) was implemented following the Centers for Medicare and Medicaid Services (CMS) approval in August 2018. The QMI provides a net of about $30 million dollars (after provider tax payments) to Michigan Medicaid nursing facilities based on the 5-Star Quality Measures criteria as established by CMS. QMI is a quasi pay for performance program that provides each Medicaid nursing facility an incentive to provide the highest quality of care as measured by the CMS criteria. The program pays a pre-set monthly amount based on the QMI criteria for payment.

HCAM presented this program to MDHHS and gained legislative approval in the state Fiscal Year 2017-2018 budget appropriation act. The QMI program will be ongoing as we enter its second year, in state Fiscal Year 2018-2019.

Staff at MediLodge of Mt. Pleasant celebrated 50’s Day during National Skilled Nursing Care Week.

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Medicare Payment Change in 2019 The Centers for Medicare and Medicaid Services (CMS) released the rule that changes the Medicare Resource Utilization Groups (RUGs) payment mechanism for Medicare Part A Skilled Nursing services to Patient Driven Payment Model (PDPM). PDPM focuses on the overall health issues of the beneficiary with less focus on therapy services. The American Health Care Association (AHCA) has worked extensively with CMS to develop this new payment model and will be providing many opportunities to learn the new system. AHCA has a PDPM 101 webinar currently available to members offering a good place to gain basic knowledge. We will have various education programs to assist your facility in learning the new system. This change will take effect October 1, 2019, just months away!

Medicare and Medicaid Reimbursement HCAM provided members with the latest information on the changes in Medicare fee for service (FFS) rates and coverage in 2018. HCAM computed the Medicare Prospective Payment System (PPS) rates for fiscal 2019 and with American Health Care Association (AHCA) assistance, the FSS Part B rates. Medicare and Medicaid policy changes were shared with members throughout the year in the newsletter, as member alerts and at the Reimbursement Committee meetings.

Medicaid changes in 2018 included Level of Care Determination (LOCD) process, Quality Measure Initiative (QMI) revisions, Veteran Home Medicaid rate methodology and numerous ongoing upgrades to the Community Health Automated Medicaid Processing System (CHAMPS). CMS increased the Medicare Part A Skilled Nursing Facility PPS rates by 2.4 percent, providing more than $820 million in increased payments across the nation.

MI Choice Home and Community Based Waiver (HCBW) Michigan’s MI Choice HCBW program began in 1992 and is funded as a 1915 (b) (c) waiver program as approved by CMS. In 2014, CMS put forth a number of changes to the waiver program and Michigan was required to submit a transition plan for these changes. MDHHS filed the required transition plan and received initial approval from CMS on August 10, 2017. Final approval for the transition plan was extended by CMS until March 17, 2019. The changes, which include new guidelines for residential settings that will impact assisted living waiver providers, will need to be implemented by March 17, 2022. HCAM/MCAL continues to work with the state of Michigan and the waiver agents on heightened scrutiny and other barriers that may exist for HCBW use in assisted living settings.

Certificate of Need Michigan nursing facilities operate under a Certificate of Need (CON) program that determines the need for beds based on population and utilization of services. The CON Commission is required to review the bed need for each county in Michigan every two years. The latest review was performed in 2017 and showed a need for more than 8,000 new beds from the current need. HCAM disagreed with this review and the need for more beds considering the ongoing decrease in occupancy. We presented our concerns before the commission and in February 2018 the commission agreed to not accept the revised bed need report. The commission also agreed to review the bed need methodology when the standards come up for review in 2019. HCAM was pleased with their actions and is looking forward to the review in 2019.

Jackson County Medical Care Facility hosted a party in honor of David Lebenbom memorial scholarship winner, Miranda Brown.

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Legal/Regulatory/Clinical Michigan Public Health Code - Rule Revisions The workgroup was started late in 2017, focused on combining the current rule sets for the six individual health facilities as defined under the public health code into one combined rule set. These revisions will eliminate a number of outdated nursing facility rules and create parity with other settings once implemented. We anticipate these revisions will be scheduled for final promulgation in spring of 2019.

Home for the Aged administrative rules are not currently addressed in this process, however it is anticipated they will come under review in the coming year. Additionally, MCAL provided numerous education opportunities to learn about the changes to HFA rules which allow for a process for licensure exemption in specific situations. A webinar is archived at www.hcam.org to learn about the changes that became effective in February of 2018.

Nursing Home Administrator Rules are also being revised and are also close to completion. These revisions include moving Michigan to adoption of both the National Association of Long Term Care Administrator Boards (NAB) Core of Knowledge (CORE) and Line of Service (LOS) exams for licensure. This change creates much more flexibility in obtaining Michigan licensure to Nursing Home Administrators licensed in other states.

The association worked with provider groups to add language to the new Opioid laws that recognized the unique position of nursing facilities and assisted living communities. These new laws added requirements for counseling, education and consent forms, checks of the Michigan Automated Pharmacy System (MAPS), and establishment of a Bona-Fide Prescriber Relationship prior to issuing a prescription for an opioid medication. We were successful in defining the long term care setting as exempt from many of the new requirements of these laws. In addition, language was added to the Bona-Fide Prescriber requirements that recognized situations in which one provider was covering for another, or a provider was accepting a transfer from an inpatient care setting such as in an admission to a nursing facility. These combined efforts resulted in eliminating added burdens to our providers.

Informal Dispute Resolution Process This summer, HCAM began work with the Department of Licensing and Regulatory Affairs (LARA) the Michigan Council of Medical Care Facilities (MCMCF) and LeadingAge Michigan to review and revise the current Informal Dispute Resolution (IDR) process to create greater transparency and offer providers the opportunity to include clarity when presenting their dispute.

The updated process would allow a provider to choose between a reviewer at LARA who has not been involved in the survey, or an independent reviewer at Michigan Peer Review Organization (MPRO.) The provider will also be offered the opportunity to participate in a telephonic session with the reviewer to offer greater clarity and discuss the specifics of HCAM/MCAL recognized the 2018 award winners in Grand Rapids during the annual convention and expo.

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the dispute. A quality improvement process is expected to be incorporated into the review process to help providers, LARA and MPRO learn and improve future IDR submissions. In addition, LARA has agreed to accept MPRO recommendations without further review or dispute.

Martha T. Berry Medical Care Facility hosted a ground breaking ceremony in May. Quality Reporting Program This fall, HCAM provided a full day educational session as a member benefit on the new Quality Reporting Program (QRP). The QRP was required by the IMPACT Act that created standard measures across providers and includes a two percent penalty to Medicare rates for missing data or a failure to report. The QRP changes went into effect on October 1, 2018. Data collection is enabled through a significant number of MDS Assessment changes, and is being publically reported through new quality measures. HCAM hosted approximately 160 members at the training, where the group learned new coding requirements and strategies for operational changes to ease and guide workflow changes expected with implementation. The changes incorporated into the QRP program are moving providers a step closer to the implementation of PDPM on October 1, 2019.

Partnering with AHCA/NCAL HCAM/MCAL has worked hand in hand with AHCA/NCAL to provide updates, tools and training to support members. Recent updates include changes to the Five Star Measures expected to be implemented in Spring 2019. These changes include updates to the staffing and quality measure components along with the overall rating system. AHCA has advocated aggressively that Centers for Medicare and Medicaid Services (CMS) never go back to the curve ranking on the Quality Measures.

This year NCAL added the AL Cost Calculator to the growing list of tools available to MCAL members. The AL Cost Calculator is a web-based, enhanced resident assessment tool that allows assisted living providers to assess how costs are allocated across residents, allowing for targeted staffing decisions. Members should also take advantage of the LTC Trend Tracker and the Quality Initiatives among other NCAL offerings.

LARA/BCHS LTC Stakeholders Workgroup Throughout 2018 and continuing forward, HCAM remains an active participant in the Department of Licensing and Regulatory Affairs/Bureau of Community and Health Systems Long-term Care Stakeholders Workgroup. We continue meeting with leaders in the Bureaus of Community and Health Systems and Professional Licensing to proactively work to improve care and relationships as well as to address concerns brought forward by membership.

Medication Aide Legislation Ready for Passage in 2019 HCAM has led legislative efforts to establish and recognize medication aides in the nursing facility setting. This role is based off of the current Regency at Grand Blanc hosted an ice cream social for first responders during National Skilled Nursing Care Week.

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Certified Nursing Assistants (CNAs) requirements and provides an opportunity for a qualified CNA to complete additional education and testing to become a medication aide.

Not only will this role provide an option for providers to augment their staffing complement and increase RN assessment and planning with resident care, but it will create a stepping stone for advancement to current qualified CNAs. A group of stakeholders including representation from the Department of Licensing and Regulatory Affairs (LARA), Bureau of Professional Licensing, Michigan Board of Nursing, varied nursing organizations, educational institutions, legislators and providers has worked diligently through the past months to identify and address concerns arising from the proposed legislation.

The legislation closely mirrors the statutory framework in place for nurse aides to establish a medication aide registry. Responsibilities of medication aides would include administering regularly scheduled medication under the supervision of a registered nurse. The legislation clarifies that medication aides would not be permitted to administer controlled substances, medications in injectable forms, or the initial administration of medications. The core duties of nursing will remain with the nurses in the facility – medication aides will simply provide further support to help provide residents with the care they need.

Though House Bill 6037 did not make it through the legislative process in 2018, progress was made to ensure the bill is prepared for passage in 2019. Representative Ben Frederick has expressed his intention to champion the bill as sponsor in 2019.

Public Policy & Advocacy The 99th Legislature concluded with one of the busiest lame-duck sessions in recent memory.

Throughout the 2017-18 legislative term, HCAM monitored, tracked, and engaged in a number of bills impacting long term care. As issues arise, association staff, board members, and facility employees met with legislators and testify in legislative committee hearings to address concerns. The association advances our initiatives and supports many bills, but also prevents advancement of bills having negative consequences for the profession. The following highlights major legislation worked on in 2018.

Medicaid Process Reform Legislation Received Mixed Results A multi-year effort to fix delays in cost report audits and other deficiencies in the Medicaid reimbursement process culminated in the legislature sending Senate Bills 1037, 1038, and 1039 to the governor during lame-duck. While Governor Snyder used his veto power to reject Senate Bills 1037 and 1039, he did sign Senate Bill 1038. The governor also signed into law SB 601, which included updates to the CAV limit policy. The enactment of SB 1038 is a significant success, along with the increase in the CAV limit. HCAM will continue efforts in 2019 to address the provision in SB 1037 and 1039.

State Representative Tim Sneller, center, talked with HCAM staff Richie Farran and Melissa Samuel during the grand opening of WellBridge of Grand Blanc.

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The following are the major provisions of each bill:

Senate Bill 601 In working with Governor Snyder's policy advisors and the State Budget Office, HCAM agreed to address changes to the current asset value (CAV) limit. Rather than being included in statute, this change was made in the supplemental appropriations legislation by the legislature (Senate Bill 601). The language in the supplemental appropriations bill mandates the Michigan Department of Health and Human Services (MDHHS) to update the CAV limit policy in the Medicaid Provider Manual to use a 15year rolling history of construction costs. This update will result in a significant increase to the CAV limit in fiscal year 2020. For fiscal years 2021 forward, annual increases to the CAV limit will not exceed four percent of the previous year limit. These changes are improvements to the bill and will result in a greater CAV limit for providers. The new policy will take effect October 1, 2019.

Senate Bill 1037 SB 1037 would have updated the Medicaid non-available bed plan to allow beds to be placed in escrow for up to five years. The new plan would have also allowed for non-contiguous beds to be placed in escrow, and the square footage associated with each escrowed bed would This photo from Mill Creek Assisted Living have been non-reimbursable. Senate Bill 1037 also was the winner of MCAL’s Capture the required reinterpretations of existing Medicaid policy to be Moment Contest. applied prospectively to ensure notice is given to providers.

Senate Bill 1038 Currently, cost reports are due to MDHHS five months after the completion of the provider’s cost reporting fiscal year, and the state has the authority to stop payments to facilities that do not meet that deadline. Senate Bill 1038 maintains that requirement, but also places timelines on MDHHS. The bill allows MDHHS two months to accept the filing of a cost report, twenty-one months to complete the audit of a cost report, and two months to settle a cost report. If MDHHS does not meet the timelines, the cost report must be accepted as filed. Senate Bill 1038 also requires MDHHS to complete audits of backlogged cost reports within two years of effective date of the bill. If MDHHS fails to do so, the backlogs will be accepted as filed.

Senate Bill 1039 Senate Bill 1039 would have required MDHHS to allocate long-term care eligibility applications to trained case workers to ensure a determination is made within the 45-day standard of promptness.

For redeterminations, MDHHS would have been required to use electronic asset detection and verification, and provide a pre-populated application to allow for an abbreviated process.

The bill would have required MDHHS to make available an outstation worker upon the request of a facility. Outside the legislation, MDHHS has recently issued policy that facility costs for outstation workers are no longer reimbursable on the Medicaid cost report.

SB 1039 also would have required MDHHS to deduct any court-ordered payments or garnishments from a resident’s income before determining their patient-pay amount.

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Adult Foster Care Licensing Bills Signed by Governor Snyder House Bills 5505 and 5506 were passed during the lame-duck session. The legislation makes various updates to the licensure procedures, fees, inspection, and appeals provisions in the Adult Foster Care Licensing Act. The Department of Licensing and Regulatory Affairs (LARA,) which currently covers the costs of background checks, recommended these costs be covered by facilities, along with an increase in licensing fees. HCAM/MCAL negotiated with bill sponsors and LARA to mitigate the increased cost, with a graduated fee increase and delaying the shift in costs to facilities to July 1, 2020.

Homes for the Aged Licensure Law Takes Effect Public Act 167 of 2017 took effect in 2018. This act has significant impact on Homes for the Aged and non-licensed communities. In February of 2018 the following changes took effect: existing non-licensed communities could qualify for licensure under Life Safety Code for board and care requirements under certain circumstances; the term Supervised Personal Care is now defined in statute; and under specific circumstances as laid out in the act, a facility that might otherwise be determined to need an HFA license may qualify for an exemption from licensure. Additionally, partial responsibility for the cost of background checks was passed on to HFAs effective October of 2018. Also, a capped number of state paid background checks was implemented.

Educating Legislators on the Quality Care Provided by Michigan Nursing Facilities A number of bills introduced during the 2017-18 legislative term would have had an adverse impact on the profession. This included requiring installation of cameras in resident rooms, requiring redundant investigations by adult protective services for facility reported incidences, changing the rights of residents and their guardians, and allowing elderly prisoners to be paroled into nursing facilities. HCAM spent a considerable amount of time advocating against these bills and educating legislators and staff on the myriad of regulations and intense oversight currently on providers.

Ultimately, we were successful in pushing back against these bills. Most adverse legislation arises due to a misunderstanding of the way the iprofession is regulated, and the high quality care provided to residents. In 2019, the association will launch a campaign focused on quality of care offered by providers to educate legislators and change the negative perception that often leads to adverse legislation.

Government Advocacy The association uses a variety of tools and activities on working with state government officials. Visit www.HCAM.org or www.michcal.com and click on Government Advocacy Services where you will find numerous options to learn about issues HCAM is working on at the state capitol.

Legislative Tracking Document HCAM/MCAL tracked and engaged on over 125 bills impacting our profession and has directly negotiated with bill sponsors to have language changed and testified before committees.

Schnepp Senior Care and Rehab Center celebrates winning the Calvin H. Monfils Facility Excellence Award.

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Monthly Legislative Updates Senators and Representatives stay informed on current budgetary, regulatory and legislative issues impacting our profession through updates sent to their offices.

Year End Report to the Michigan Legislature In 2018, HCAM once again distributed a Year End Report to the Legislature. This collection of thank you letters, arranged by county, helps to show the Legislature the positive actions and outcomes that occur every day in our facilities.

2018 HCAM PAC Campaign Thank you to all who made donations to the 2018 HCAM PAC Campaign. The 2018 campaign fell short of 2017, which was the best to-date. HCAM/MCAL members generously donated more than $91,000, allowing us to play a significant role in fundraisers and political events throughout the year.

The HCAM PAC proved to be critical in building relationships with new elected officials, including Governor Gretchen Whitmer and leadership in the House and Senate.

Quality and Education HCAM/MCAL Have Gone Platinum – Celebrating 70 Years 2018 was a milestone year as HCAM celebrated its 70th Anniversary. Through the years, our educational programming has evolved to meet the changing needs of our members. One of our goals throughout this year was to refocus our educational offerings on the membership’s needs. In order to do so, the association restructured the education committee to a small cohort of members dedicated to identifying gaps in knowledge, skills, and practice of long-term care professionals in order to provide timely, appropriate education to the membership.

The association continues to encourage members and partners to submit ideas and requests for education that will assist facilities/centers in continuing to improve their daily operations as well as their long-term strategic plans. All submitted ideas will be reviewed by the education committee.

Virtual Education In 2018, we worked diligently to expand our educational offerings including establishing monthly webinars and enhancing a robust library of on-demand virtual education. Topics included short-term quality measures, MDS 3.0, requirements of participation, opioid diversion, surveyor tools and an MCAL webinar regarding Public Act 167.

Gold Award Seminar In 2018, the association expanded our quality awards programming to include a workshop for Gold applicants. The AHCA/NCAL National Quality Awards Program is a progressive program that is based on the Baldridge Criteria for Performance Excellence.

Advantage Warren held a party on their patio for National Skilled Nursing Care Week.

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Gold recipients represent an elite group by meeting all the demands of the Baldridge Criteria, they demonstrate the achievement of high levels of performance over time in the areas of leadership, strategic planning, customer and workforce, operations, and knowledge management.

Complimentary Member Benefit Programs In order to provide high-quality, emergent education to members, the association provided two complimentary programs for members in 2018:  SNF Quality Reporting Program Seminar: This program was put together to help members prepare for the SNF Quality Reporting Program for FY 2019 which requires over 105 changes David Lebenbom Memorial Scholarship winner, Samara to the MDS. Vazquez from Regency at Whitmore Lake, interacts with a  Quality Measure Initiative resident.

Webinar: This webinar was established to provide members with an overview of the QMI program and the effect it has on nursing facilities rates and cost reporting.

Future Leaders Level Two HCAM/MCAL reintroduced a renovated program in 2018 – Future Leaders Program Level 2. The purpose of this program is to further develop successful leadership roles and expand their efficacy as a leader in the health care profession. This three module program covers information from leadership greats such as Maxwell, Lencioni and Cottrell and develops understanding of team dysfunctions, communication and growing a team – with facilitated self-application of the principals explored.

Elevating the Assisted Living Workforce Throughout 2018, MCAL continued to provide best practice programs to enhance the skills and knowledge of the workforce. MCAL’s signature program, the Certified Assisted Living Director (CALD) program, provides high caliber training to prepare executive directors in Michigan for the NAB national exams and provides a voluntary certification for assisted living directors in the state of Michigan. This is administered and maintained with a CE requirement by MCAL. MCAL also offers a Medication Management Train-the-Trainer program to prepare trainers to teach their staff how to safely and effectively assist residents with medication management while staying in compliance with state regulations.

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Thank you to our volunteer committee chairs and board members. Their efforts to help shape the association and our profession are appreciated.

HCAM Committee Chairs MCAL Committee Chairs Finance: Dick Prestage Regulatory/Legislative: Todd Dockerty & Jon Zima Public Policy: Jeff Schade Marketing & Communication: Joel Fox & Jennifer Hescott Managed Care: Karen Messick Managed Care: Karen Messick & Mike McElroy Reimbursement: Kathy Winkels MCAL Education: Debra Mittelbach & Holly McMurray Legal/Regulatory/Clinical: Paul Pruitt Quality Committee: Laurie Shepard Quality and Education: Vickie Burlew Executive Committee: Mike McElroy Education: Season Maranich Nurse Education Committee: Carole Stacy & Karen VanDamme Nomination: Frank Wronski 2018 HCAM Board of Directors Henry Boutros, Blake Church, Gail Clarkson, Patrice Farmer, Barney Foland, John Gaynier, Darren Gee, Laura Hamann, Reginald Hartsfield, Margaret Lightner, Andrea Logan, Barbara Lombardi, Karen Messick, Mark Piersma, Chester Pintarelli, Doug Postlewait, Richard Prestage, Jeffrey Pries, Andrew Rothman, Jeff Schade, Richard Shook, David Stobb, Chad Tuttle and Frank Wronski.

2018 MCAL Board of Directors Scott Ganton, Jennifer Hescott, Melissa Hinkson, Ralph Mason, Joe LeBlanc, Mike McElroy, Karen Messick, Debra Mittelbach, Debra Murrey, Lyle Robinette, Andrew Rothman, Laurie Shepard, Steven Tyshka, Wayne Vanderkolk and Jonathan Zima.

Tropical photo booth fun at Reflections Memory Care Community.

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