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1 NEW YORK STATE HEALTH FACILITIES ASSOCIATION NEW YORK STATE CENTER FOR ASSISTED LIVING NYSHFA /NYSCAL News April State Budget Summary BY: STEPHEN B. HANSE, ESQ., VICE PRESIDENT OF GOVERNMENTAL AFFAIRS On Sunday, March 24th the Governor and the Legislature reached agreement on the final provisions of the State Budget. The Senate completed passage of the budget during the early hours of March 27th and the Assembly passed the budget on Thursday, March 28th. With the State s fiscal year beginning April 1st, this is the third consecutive year that the State has enacted an on-time budget. Standard Wage for Nursing Homes Defeated of Continuing Health Care in New York State As you are well aware (and as mentioned in the Advocacy Day article), the budget bills initially proposed by the Governor and the Assembly included statutory language that would require managed care contracts for in-patient nursing home services to provide standard (i.e. prevailing) rates of compensation to ensure the retention of a qualified workforce. These budget proposals sought to legislatively establish a floor for nursing home wage compensation throughout the State, but without a commitment to provide the necessary funding. These unfunded budget mandates threatened the operation of existing skilled nursing facilities, diminished access to necessary care by prohibiting admissions in certain circumstances, and failed to recognize the significant financial hardships presently facing New York s long term care providers. Consequently, NYSHFA immediately and vigorously opposed these proposals. Beginning on Tuesday, January 22nd (the day the Governor unveiled his proposed budget) and continuing right through Sunday, March 24th, NYSHFA worked tirelessly with legislators, policymakers and affected associations in an effort to exclude this proposal from the final budget. From numerous meetings, discussions, legislative visitation efforts, telephone calls, to letter writing campaigns, opposition memos, and many other proactive efforts, NYSHFA employed all possible means to exclude this damaging proposal from being enacted. We are delighted to report that the standard wage proposal was excluded from the enacted budget! Enacted Budget Summary The following is a summary of the major provisions impacting NYSHFA and NYSCAL members included within the enacted New York State Budget. IN THIS ISSUE: President s Message Page 2 Events & Dates Page 3 Governmental Affairs Pages 4-6 Clinical, Quality and Operational Services Page 7 Foundation for Quality Care Pages th Annual Convention & Trade Show Pages Trend Factor: The final budget rejected the Governor s original proposal to eliminate the Legislature s ability to set trend factor adjustments for nursing homes, assisted living program beds and other Medicaid sectors but continues the 0 percent trend factor for the 2013 and 2014 calendar years. Restoration of the 2 Percent Across the Board Cut: The final budget authorizes the restoration of the 2 percent across-the-board cut at any period between April 1, 2013 and March 31, This restoration language is included within the section of the budget providing for the establishment of the Mental Hygiene Stabilization Fund to plug the $1.1 billion budget shortfall the State is facing in the fiscal year as a consequence of its longstanding history of overbilling Medicaid for the institutional care of individuals with developmental disabilities New York State Health Facilities Association Inc. Medicaid Global Spending Cap: The final budget continues the Medicaid Global Spending Cap through the fiscal year. Continued on page 6 Support, Service and Value. visit:

2 A Message from the President DICK HERRICK, PRESIDENT AND CEO Some of the best business advice I have ever heard came from the former chairman of the board and CEO of General Electric, Jack Welch who when questioned during one of his many speaking engagements about his vision for the future of business responded, Don t be smart enough to predict the future, just be flexible enough to react to it. There is no greater example of this advice than the recent budget season that was completed April 1, When trying to set a placeholder date each new budget year, NYSHFA, 12 months in advance of that budget, will pick what we think might be the best date to have Legislative Visitation Day, as we have known it in the past. This year having set a date of March 19, little did we know that the Governor and the Legislature would determine that their goal would be to complete the budget by March 22 rather than April 1 because of the Passover and Easter holidays. The Government Relations team here at NYSHFA together with your Executive Committee determined that if that schedule was maintained by the Governor and the Legislature the timing of our LVD was too late in the budget process. This became especially evident after examining the budget release which came on January 22 and realizing there were a few major issues that needed to be addressed. One major proposal by the Governor s office at the urging of SEIU 1199 was setting standardized wages for nursing homes (otherwise known as Prevailing Wage) which NYSHFA very quickly and adamantly opposed. Our Executive Committee, Legislative Committee together with the Government Relations team quickly swung into action, changed our Legislative Advocacy Day to February 27, engaged with our membership to attend, pulled together a multi-association collaboration, and focused on the leadership of the legislature to ultimately defeat that proposal. We are taking the same approach as it relates to managed care and other major issues we see on the horizon for which there are few details. We continue to analyze proposals, reach out to the agencies involved, utilize our national affiliate the American Health Care Association and utilize the experience of other states that are dealing with the same proposal. Through our various committees we continue to gather intelligence on all of these issues and are prepared to use the lessons learned from the budget process and be flexible enough to react in a way that best serves our members. NYSHFA staff are supporting an ever increasing number of educational opportunities for our members while serving on many more workgroups as the issues are increasing and the Department of Health have ever decreasing staff to address those issues. Managing a calendar is one of our largest tasks as it is necessary to plan ahead for all of these events while at the same time remembering that wise advice, Don t be smart enough to predict the future, just be flexible enough to react to it. Our calendar for the second quarter of 2013 continues to be active with an appreciation dinner for Senator Schumer in Washington, an Owners and CEO meeting at LaGuardia Marriott, and NYSHFA s Annual Convention at Turning Stone. I look forward to seeing you at many of those events in the near future. NYSHFA Board of Officers: Chair of the Board Gregory Chambery The Maplewood Nursing & Rehab. Center Vice-Chair of the Board Douglas Wissmann Hillside Manor Rehabilitation & Extended Care Center Secretary / Treasurer Michael McPartlon Kingsway Arms Nursing Center Immediate Past Chair - BOD Martin Liebman Grand Manor Nursing & Rehabilitation Center President and CEO: Richard J. Herrick NYSHFA /NYSCAL News of Continuing Health Care in New York State Is published by the... New York State Health Facilities Association (NYSHFA) New York State Center for Assisted Living (NYSCAL) Established in 1949, NYSHFA is an organization with a mission to create an environment which enables its members to provide accessible, efficient, quality long term care. The membership of over 270 licensed skilled nursing and assisted living facilities is geographically diversified and represents independent and multi-facility operations of proprietary, voluntary and public sponsorship. The Associations s members are dedicated to the highest standards of health care and quality of life of over 44,000 nursing facility and assisted living residents in New York State. For editorial, advertising or membership information, contact: Joanne O Connor Communications & Business Development Coordinator NYSHFA/NYSCAL 33 Elk Street, Suite 300, Albany NY (518) Fax: (518) The acceptance of a product, service or company as an advertiser or a manuscript for publication does not imply endorsement or approval of the product, service, company or opinion. NYSHFA urges all members to exercise good judgement when purchasing any product or service. 2 4/13 NYSHFA /NYSCAL News

3 Directors 2012/2013 District Representatives:: District 01E Representative Mary Ann Mangels Riverhead Care Center District 01W Representative Joseph Carillo Carillon Nursing & Rehab. Center District 02 Representative David Moskowitz Cold Spring Hills Center for Nursing & Rehab. District 03 Representative Scott Wheeler Cortlandt Healthcare District 04 Representative Steve O'Neill Stephen O'Neill, CPA, PLLC District 05 Representative Mark Olsen KingsWay Arms Nursing Center District 07 Representative Wheeler Maynard St. Regis Nursing Home District 08 Representative Denise Johnson Vestal Nursing Center District 09 Representative James Bicker Hornell Gardens District 10 Representative Anna Bojarczuk-Foy ElderWood Health Care at Wedgewood District 11 Representative Lowell Feldman Terrace Healthcare Center Inc. District 12 Representative Judith Dicker Hillside Manor Rehabilitation & Extended Care Center District 13 Representative Simon Pelman Union Plaza Nursing Home NYSCAL Representative Randy Muenzner ElderWood Senior Care April 26 CMS Quality Measures and the 5-Star Rating System What s the Impact? Audio Conference 10:00 AM to 12:00 PM The CMS Revised Quality Measures play an important role in determining the facilities 5 Star Quality Rating System posted on the CMS Nursing Home Compare website. The CMS Nursing Home Quality Measures are based on MDS 3.0 data submitted to the QIES ASAP system. This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 2.0 clock hours for LNHAs and Assisted Living Administrators. To register, contact NYSHFA s Education Department or visit: May 7 Managing the Double Standard : Reconciling Federal v. State Audit Initiatives Audio Conference 10:00 AM to 12:00 PM SNFs are being forced to manage a host of audit initiatives from Medicare and Medicaid. While both the Federal PPS and State CMI systems use the MDS to adjust acuity-based payment, there are many inconsistencies regarding expectations, standards and outcomes among the government and their third party auditors (e.g., MACs, OMIG, ZIPCs, etc.). This program will review recent audit activity and offer strategies to successfully manage the different requirements to ensure that your documentation and response process is efficient, compliant and effective. The presenters will focus on the ongoing OMIG audits of facilities that realized a 5% increase in CMI from January January 2012, including processes and early findings. To register, contact NYSHFA s Education Department or visit: May National Nursing Home Week We re proud to announce the 2013 theme for National Nursing Home Week: Team Care. Nursing Home Week will be observed in skilled nursing facilities throughout America, beginning Mother s Day, May 12 and continuing through May 18, NNHW s theme recognizes residents and patients in long term and post-acute care settings, the dedicated staff who care for them, and the value of care planning where everyone pitches in for optimal outcomes. The observance is an opportunity to involve families, community members, youth, and others in a community-wide show of support and respect for these individuals and the staff who provide care or support services. Activities are designed to foster intergenerational contact, strengthen family relationships and to encourage volunteerism by individuals and local organizations. More information is available at the dedicated web site: and on Facebook. May 29 Are You Ready For The New HIPAA Omnibus Rule? Audio Conference 10:00 AM to 12:00 PM In what has been referred to by the Health and Human Services ( HHS ) Office of Civil Rights director as the most sweeping changes to the HIPAA Privacy and Security rules since they were first implemented, the HIPAA Omnibus Final Rule ( Final Rule ) was issued by HHS on January 17, 2013 and is effective March 26, The compliance deadline for most obligations is September 23, Two (2) CEUs are available for LNHAs & AL Administrators. To register, contact NYSHFA s Education Department or visit: June rd Annual Convention and Trade Show Turning Stone Resort & Casino Verona, NY Come join your fellow members at the Turning Stone Resort! See more Convention news on pages 14 and 15. To register visit or contact NYSHFA s Education Department. NYSHFA/ NYSCAL Events and Dates 4/13 NYSHFA /NYSCAL News 3

4 Governmental Affairs NYSHFA & NYSCAL Albany Advocacy Day BY: STEPHEN B. HANSE, ESQ., VICE PRESIDENT OF GOVERNMENTAL AFFAIRS On Wednesday, February 27th NYSHFA and NYSCAL members from throughout New York travelled to Albany to meet with key legislators and policymakers for a targeted State budget advocacy day. As a result of the deadline set by the Governor and legislative leaders to complete the State budget prior to April 1st, it was crucial for NYSHFA and NYSCAL members to educate decision makers in a timely manner given the considerable impacts the Governor s budget proposals would impose upon New York s skilled nursing and assisted living providers and the women, men and children we serve. Throughout the day, NYSHFA and NYSCAL members met with elected officials and policy makers to discuss both our support and opposition for specific proposals contained within the Executive budget. Foremost among the proposals our members sought to exclude from the budget was an initiative advanced by the Governor that would statutorily require managed care contracts for in-patient nursing home services to provide standard (i.e. prevailing) rates of compensation to ensure the retention of a qualified workforce (a similar version was also included in the Assembly s March 8th budget proposal as well). NYSHFA s and NYSCAL s efforts were successful as this unfunded mandate was ultimately excluded from the final budget (See Budget Summary Article). In addition to the standard wage proposal, NYSHFA and NYSCAL members advocated for the rejection of other specific proposals contained within the Executive budget, including those that would: Eliminate the Legislature s ability to set trend factor adjustments for inflation; Continue the 2 percent across-the-board provider rate cut; Extend the Medicaid Global Spending Cap; and Eliminate funding for financially disadvantaged facilities. Throughout the day, NYSHFA and NYSCAL members also advocated in support for the following items to be included within the enacted budget: Capital construction costs in assisted living program rates (ALP) for all ALP providers; A simplified process for providers to secure the additional 4,500 assisted living program beds for the newly identified 49 Transitional Adult Home providers affected by the most recent regulations published by the Department of Health; A fast-track ALP approval process for transitional adult home providers; and Recognition of resident choice and the establishment of a realistic and workable timeline for the implementation of the newly adopted regulations affecting transitional adult homes. Please see the budget article for a summary of the final enacted budget. 4 4/13 NYSHFA /NYSCAL News

5 Senator Joseph Griffo (right) hosts meeting. Senator Patty Ritchie (at head of table) and members discuss the issues. Governmental Affairs Senator Dean Skelos (center) welcomes NYSHFA members ADVOCACY DAY Legislative Committee Chair Mark Olsen and NYSHFA representatives join Executive Committee members Greg Chambery, Doug Wissmann and Mike McPartlon on the floor of the NYS Senate. Long Island well represented. Senator Joseph Robach (2nd from left) greets District 9 and 10 members. 4/13 NYSHFA /NYSCAL News 5

6 Governmental Affairs Senator Hannon Reception On Tuesday, March 19th the NYSHFA/ NYSCAL Committee for Action for a Responsible Electorate ( CARE ) hosted a reception in Albany in honor of New York State Senator Kemp Hannon. As Chairman of the Senate Health Committee, Senator Hannon strives to promote policies that enable skilled nursing and assisted living facilities to provide high quality, accessible and efficient health care services throughout Continued from page State Budget Summary Financially Disadvantaged Facilities: The final budget directs $30 million in financially disadvantaged facility funding to establish rate adjustments for facilities undergoing merger, acquisition or closure plans pursuant to existing DOH regulations. 4,500 Additional Assisted Living Program Beds: The final budget adds up to 4,500 additional assisted living program beds for the newly identified 49 Transitional Adult Home providers affected by the recent regulations published by the Department of Health. Eligible adult homes are those homes in New York with a certified capacity of 80 beds or more as of September 1, 2012 in which 25% or more of the resident population has a serious mental illness. Assisted Living Program Capital: The final budget bill provides for the inclusion of capital construction costs in the assisted living program rate for facilities exclusively housing assisted living beds. New York State. During the reception, Greg Chambery, Chairman of NYSHFA s Board of Directors and Stephen Hanse, Esq., Vice President of Government Affairs for NYSHFA/NYSCAL, presented Senator Hannon with a plaque commemorating his longstanding leadership on issues impacting skilled nursing and assisted living facilities throughout the State. DOH Appointment of a Temporary Operator: The final budget authorizes the Commissioner of Health to appoint a temporary operator of an adult care facility, an assisted living residence, a general hospital, a diagnostic and treatment center, or a chemical dependence treatment program certified by OASIS on a temporary basis in certain circumstances of financial instability or when the Commissioner finds there are conditions within the facility that endanger the life, health and safety of the residents. SUNY Downstate Hospital Sustainability Plan: The final budget requires the SUNY Chancellor to submit a sustainability plan on or before June 1, 2013 setting forth recommendations for restructuring SUNY Downstate for the purpose of achieving fiscal viability while preserving its status as a teaching hospital. The sustainability plan is subject to the approval of the Commissioner of Health and the Director of the Division of the Budget, and the Chancellor is required to initiate the implementation of the plan by June 15, Health Home Infrastructure: The final budget includes up to $15 million in state monies to develop and enhance health home operations including assignments, workflow and transmission of data. Amendments to Existing Contracts: The final budget authorizes the Commissioner of Health to amend or modify any contract entered into by the DOH prior to January 1, 2013 without the need for competitive bidding or an RFP. Such amendments or modifications are to allow for additional personnel or services for the limited purpose of assisting the DOH with implementing the Balancing Incentive Program, the Fully Integrated Duals Advantage Program, the Vital Access Provider Program, the Medicaid waiver amendment associated with the public hospital transformation, the addition of behavioral health services as a managed care plan benefit, and the establishment of certain workgroups. Report Audit Authority: The final budget extends audit authority for calendar year 2002 cost reports filed by nursing homes through December 31, Reconciliation: The final budget eliminates the requirement that certain rate adjustments for 2007 and 2008 for nursing homes be subject to reconciliation. The following initiatives advanced by the Governor in his original budget proposal were among those that were rejected in the final budget agreement: Authorizing the DOH to establish capital reimbursement methodologies for nursing homes through regulation (including emergency regulation); Eliminating the cap on the maximum number of managed long-term care plans that can be authorized (the cap is currently at 75); Developing a pricing reimbursement methodology for specialty nursing homes; and Requiring spousal support for the costs of communitybased long term care. Minimum Wage: The final budget increased the minimum wage in three steps starting with an increase to $8.00 on December 31, 2013, $8.75 on December 31, 2014, and $9.00 on December 31, Continued on page /13 NYSHFA /NYSCAL News

7 NYSHFA Members Present at AHCA s Annual Quality Symposium Susquehanna Nursing and Rehabilitation Center presented an abstract of their Tackling Avoidable Readmissions; CHF Purple Heart Program at AHCA s Annual Quality Symposium in San Antonio, Texas on February 12-13, Shannon Cayea- Delker, Administrator and her staff actively took on the challenge as part of AHCA s Four Goal Quality Initiative. The team was able to significantly reduce unplanned hospitalizations by utilizing quality improvement processes including root cause analysis to identify the main reasons for their hospitalization rates and implement specific strategies of earlier assessment and intervention to accomplish their goal. Jeni Demarais, Assistant Administrator, LNHA; Tammy Marshall, RN, DON and Cookie Travis, Director of Admissions at Susquehanna were on hand to present and discuss their initiative. This group has also been selected as one of NYSHFA s Innovative Practice award winners and will present their project at NYSHFA s annual convention in June at Turning Stone Casino, Verona, NY. Gold STAMP Gains Recognition Nancy Leveille, RN, MS Sr. Director, NYSHFA, Debora LeBarron, RN, BS, Sr. Director, Continuing Care, HANYS and Jackie Pappalardi, RN, BS Director Residential Services, Office of Long Term Care, NYSDOH were invited to present at the AHCA Quality Symposium in San Antonio, Texas in February to discuss the cross continuum project to prevent and reduce pressure ulcers in Hospitals, Skilled Nursing Facilities and Home Care. This has been a five year project to bring clinical staff from different parts of the health continuum to work together in collaboratives utilizing evidence based practice and sharing expertise and educational events to prevent, assess and treat pressure ulcers effectively. In addition, Dr. Jeffrey Levine, an expert in the field of Pressure Ulcer and Wound Care Management and a member of our Gold STAMP Advisory Committee, submitted and had his abstract accepted on the topic of Physician Engagement into the Gold STAMP collaborative process to AMDA s National Conference in Washington, DC in March. Clinical, Quality and Operational Services For more information about Clinical, Quality and Operational Services, contact: Nancy Leveille at or Karen Morris at 4/13 NYSHFA /NYSCAL News 7

8 Foundation for Quality Care Singing Up a Storm, an A Capella Benefit Concert The Foundation for Quality Care, and Bethacapella, a group of four 8th grade girls in the Capital Region, collaborated to present Singing Up a Storm, a benefit concert featuring five local a capella groups on March 16, The concert raised $3,481 for the Hurricane Relief Fund, and raised the spirits of more than 300 people who attended that evening. At the time of this publication, the Long Term Care Heroes Hurricane Relief Fund has raised over $63,000 and has supported 68 long term care heroes. The goal of the concert was to continue to assist the Long Term Care Heroes whose lives were personally impacted by Hurricane Sandy. The singing groups spanned the generations and included the following middle school, college, and professional singing groups: Bethacapella is a group of four 8th grade girls at Bethlehem Middle School who took their love of singing and established an a capella group in 2011 to perform in the Albany area community and for residents in nursing homes and assisted living facilities. Following Hurricane Sandy, the group became aware of nursing homes in the New York City and Long Island region that had evacuated residents, and whose dedicated workers were personally impacted. They wanted to do something to help. Shaker Jr. High Treble Makers A Select, All Girl Ensemble Chorus from Shaker Jr. High School. Members are all in 7th or 8th Grade, led by Ms. Erin Slater, a member of the Shaker Jr. High Music Department. In addition to performing at school concerts, they perform at nursing homes, senior centers, local malls and a variety of festivals. Capitaland Chorus Capitaland Chorus of Albany, New York is an award-winning chapter in Region 16 of Sweet Adelines International. They are an all women s barbershop chorus with approximately 25+ members, from ages , with varying interests, backgrounds and occupations, who live and work in six counties in and around the Capital District, all of whom are dedicated to the art of four-part a cappella singing. Throughout the year, the entire chorus or smaller ensembles and quartets continue to promote their craft, performing for various community events, assisting charitable groups with fundraising, performing in their chorus show, and spreading cheer through Singing Valentines and Harmony Grams. Golden Notes The Golden Notes is the mixed a capella group at The College of Saint Rose! Formed only a few short years ago by some very determined and enthusiastic students, The Golden Notes consists of a wide variety of students from many majors and from many years (as in freshmen, sophomore, junior, and senior)! Right now, the group has 14 members consisting of Music Education Majors, Music Industry Majors, Special Education/Elementary Education Majors, Science Majors, Communications Majors, and even Forensic Psychology Majors! Although they are all very different, they all come together to sing and perform some pretty awesome arrangements. The group is led by Jennifer Gorman. Additional Information for Golden Notes: 8 4/13 NYSHFA /NYSCAL News

9 Raises Funds for Long Term Care Heroes Racing City Chorus This ensemble group is a part of the 60 person, all-male Racing City Chorus from Saratoga NY. The Racing City Chorus was founded in 1956, and there is still one member of the chorus who has been with the group since its charter was received. They specialize in Barbershop Harmony, in unique four-part style of music created in the US in the late 1800 s. It is one of only two musical art forms that originated in the US, the other being Jazz. The Racing City Chorus has regular events in and around Saratoga like First Night, Hats Off, Final Stretch, national anthems for sporting events, churches, local Chambers of Commerce in surrounding towns and they even do charity work, singing Christmas Carols at local adult communities in and around Saratoga. And if you ever need to send a singing Valentine, you can check out their website for information: ge&itemid=1 As we have experienced with Katrina, Irene and other major natural disasters, the rebuilding process will take years, noted Rick Patterson, Executive Director of the Foundation for Quality Care, Inc. We sincerely thank Michael Klugman and the PTO at the Bethlehem Central Middle School for hosting this special event, and to all of the following sponsors and individuals involved for continuing to assist our long term care heroes with rebuilding their homes and their lives. When we have traveled to New York City and Long Island to deliver the relief checks, it has shown these dedicated employees that others care, Patterson concluded. Foundation for Quality Care A Very Special Thanks to our Supporters: Hillside Manor Rehabilitation and Extended Care Center, LLC Kingsbridge Heights Rehabilitation and Care Center Highland Nursing Home, Inc. Lane Press of Albany BCMS and Principal Michael Klugman BCMS PTO Foundation for Quality Care, Inc. Lindsay Dashew The Farman Family Michael & Polly Grenis Paul Murray The Namkoong Family Carolyn Snedeker Deborah Sokoler Chris Uhl 4/13 NYSHFA /NYSCAL News 9

10 Foundation for Quality Care Courses Survive Super Storm Sandy Oct 29, 2012 brought unbelievable water, wind and damage to our downstate facilities. As our Skilled Nursing Facility leaders were evacuating residents, taking in evacuated residents, sharing staff across settings and surviving with minimal services in many cases, the last thought they could entertain was completing their leadership course work started in September and only halfway completed. NYSHFA and the Foundation for Quality Care needed to reassess our plans to maintain the integrity of our grant funded DOH/DOL HWRI First Line Manager and Advanced Administrator courses to allow for the staff to complete them together as they started. We worked with our course instructors, host facilities, and all participants to move the last four days in each course to January and February, Both classes had been working on team building and problem solving processes in the fall and came back to class with wonderful examples of how the team worked through this disaster and maintained quality services for their residents, staff and families during this time. Flexibility and adaptability were key elements of success in completion of their course work and the participants desire to continue their education was evident. First Line Manager Participants Joseph Alfeo, Affinity Skilled Living & Rehab. Center Melinda Barnes, Kings Harbor Multicare Center Michele Christensen, Eger Health Care & Rehabilitation Center Dawn Dahlem, Suffolk Center for Rehab & Nursing Colleen Daly-Brush, Middletown Park Rehab & Health Care Center Jobsauri Decena, Waterview Hills Rehab & Nursing Center Patricia Delph, Crown Nursing & Rehab Center Charmaine Demonia, The Pines at Poughkeepsie Center Osamede Egharevba, Riverdale Nursing Home Abigail Gamiao, South Shore Healthcare Amy Greer, Cortlandt Healthcare Jesse Keitel, Oceanside Care Center Laura Krisanda, Middletown Park Rehab & Health Care Center Felicia Logiudice, Suffolk Center for Rehab & Nursing Gina Luster, Affinity Skilled Living & Rehab. Center Alex Manlapaz, DeWitt Rehab and Nursing Center Dawn Rodrigues, Richmond Center for Rehab & Specialty Care Nodira Suyumova, Palm Gardens Center for Nursing and Rehab Juliet Thomas, Bridge View Nursing Home Anna Zmujdzin, Cobble Hill Nursing Home Inc. First Line Manager Participants 10 4/13 NYSHFA /NYSCAL News

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