Attendee program for VNAA's 2015 Public Policy Leadership Conference in Washington, D.C.

1. Visiting Nurse Associations of America
PUBLIC P OLICY LEADERSHIP CONFERENCE
SEP T. 16-17, 2015 | WASHINGTON, D.C.
AT TENDEE PROGR AM
 #PPLC2015

3. 32015 PUBLIC P OLICY LEADERSHIP CONFERENCE
CONFERENCE AGENDA
2015 VNAA CONGRESSIONAL CHAMPIONS
SENATE PRIORITIES
HOUSE PRIORITIES
BACKGROUND ON KEY LEGISL ATION AND INITIATIVES
• PROTECT AND PRESERVE ACCESS TO HOME-BASED
SERVICES
• HOME HEALTH DOCUMENTATION AND PROGR AM
IMPROVEMENT ACT
• HOME HEALTH PL ANNING AND IMPROVEMENT ACT
• CARE PL ANNING ACT
• PALLIATIVE CARE AND HOSPICE EDUCATION AND
TR AINING ACT
U .S. CAPITOL COMPLEX MAP
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7
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TABLE OF CONTENTS

4. 4 VISITING NURSE ASSOCIATIONS OF AMERICA
AGENDA
7:30 AM
8:00 - 8:30 AM
8:30 - 8:45 AM
8:45 - 9:45 AM
9:45 - 10:15 AM
10:15 - 11:00 AM
11:00 - 11:30 AM
Registration Opens
Breakfast Buffet
Welcome: Overview of Conference and VNAA Policy Agenda
• Tracey Moorhead
Visiting Nurse Associations of America
• Norene Mostkoff
HCI Care Services, VNS of Iowa
Session 1: Federal Initiatives in Advanced Care Planning and Palliative Care
• Margaret Franckhauser (Facilitator)
Central New Hampshire VNA & Hospice
• Andrew MacPherson
Coalition to Transform Advance Care
• Keysha Brooks-Coley
American Cancer Society Cancer Action Network
Networking Coffee Break
Sponsored by Philips
Session 2A: Congressional Staff Panel
• Sarah Bogdan (Facilitator)
Visiting Nurse Associations of America
• Kristen Shatynski, Ph.D. (invited)
Rep. Greg Walden (R-OR)
• Kristen Donheffner (invited)
Rep. Earl Blumenauer (D-OR)
• Michael Barnard (invited)
Sen. Bob Menendez (D-NJ)
• Jane Lucas (invited)
Sen. John Thune (R-SD)
Session 2B: Presidential and Congressional State of Play
• Sarah Bogdan (Facilitator)
Visiting Nurse Associations of America
• Neleen Rubin
Rubin Health Policy Consulting
• Chris Fox
Venn Strategies
WEDNESDAY, SEPT. 16

5. 52015 PUBLIC P OLICY LEADERSHIP CONFERENCE
Lunch Buffet
Session 3: Federal Program Integrity Initiatives and Future Direction
• Molly Smith (Facilitator)
Visiting Nurse Associations of America
• John Morse
Centers for Medicare and Medicaid Services
• Latesha Walker
Centers for Medicare and Medicaid Services
• Erin Bliss
HHS Office of Inspector General
Hill Visits
Congressional Reception
Location: 902 Hart Senate Office Building
11:30 AM - 12:00 PM
12:00 - 1:00 PM
1:00 - 5:00 PM
5:00 - 7:00 PM
7:30 - 8:15 AM
8:15 - 8:45 AM
8:45 - 10:00 AM
10:00 - 10:30 AM
10:30 - 11:15 AM
THURSDAY, SEPT. 17
Breakfast Buffet and Topic Tables
Keynote: Policymaker Perspective
• Rep. Earl Blumenauer (D-OR)
Session 4: The Post-Acute Continuum of the Future and The Role of Home-based Care
• Erin Denholm (Facilitator)
Trinity Home Health Services
• Rochelle Archuleta
American Hospital Association
• Marci Nielsen
Patient-Centered Primary Care Collaborative
• David Introcaso
National Association of Accountable Care Organizations
Networking Coffee Break
Sponsored by Philips
Session 5: Home Health & Hospice Payment Reforms
• Laurence Wilson
Centers for Medicare and Medicaid Services

6. 6 VISITING NURSE ASSOCIATIONS OF AMERICA
Session 6: VNAA Value-based Purchasing Toolkit
• Molly Smith
Visiting Nurse Associations of America
Lunch Buffet Opens
Session 7: Innovation in Care Delivery and Payment Models
• Sean Cavanaugh
Centers for Medicare and Medicaid Services
Networking Coffee Break
Sponsored by Philips
Session 8: Issues in State Advocacy: Medicaid
• Lena O’Rourke (Facilitator)
O’Rourke Health Policy Strategies
• Kate Rolf
VNA Homecare of Central New York (NY)
• Tray Wade
HCI Care Services (IA)
• Dwight Wilson
Mission Hospice and Home Care (CA)
Session 9: Quality Measurement for Home Health and Hospice
Sponsored by CHAP
• Liza Greenberg (Facilitator)
Visiting Nurse Associations of America
• Karen Collishaw
CHAP
• Mary Pratt
Centers for Medicare and Medicaid Services
11:15 AM - 12:00 PM
12:00 - 12:30 PM
12:30 - 1:30 PM
1:30 - 1:45 PM
1:45 - 3:00 PM
3:00 PM - 4:00 PM

7. 72015 PUBLIC P OLICY LEADERSHIP CONFERENCE
CONGRESSIONAL CHAMPIONS
Each year, the Visiting Nurse Associations of America recognizes a select group of Congressional Champions for
outstanding leadership and support of home health and hospice. VNAA is pleased to introduce the Class of 2015: Sen.
Pat Roberts (R-KS), Sen. Mark Warner (D-VA), Rep. Earl Blumenauer (D-OR) and Rep. David McKinley (R-WV).
Please join VNAA and your colleagues from across the nation in honoring these Champions at a special reception
from 5:00 to 7:00 p.m. in Room 902 of the Hart Senate Office Building following Day One of this year’s Public Policy
Leadership Conference.
Sen. Pat Roberts (R-KS)
Roberts has addressed Medicare
documentation problems and sought
much-needed relief to the documentation
burdens of a face-to-face visit.
Sen. Mark Warner (D-VA)
Warner has worked hard to develop
solutions to improve health outcomes for
Medicare patients with chronic conditions
and promoting advanced care planning.
Rep. Earl Blumenauer (D-OR)
Blumenauer has been a leader in
advanced care planning policy and is
dedicated to improving quality of life for
all patients.
Rep. David McKinley (R-WV)
McKinley has spearheaded work to
promote policies to improve care for
seniors, including home-based care.

8. 8 VISITING NURSE ASSOCIATIONS OF AMERICA
Members of the Senate and their staff need to hear directly from home health and hospice agencies about the issues
that will impact beneficiaries and providers in their district. Listed below are key time-sensitive messages to share
with your Senator’s office. You are welcome to use these messages, or put them in your own words. This resource
is intended to support you in your conversations with the Senator and his or her staff. In a separate folder we have
provided additional information on each of these messages that you can give to the offices for their reference.
HOME HEALTH
1. Protect and Preserve Access to Home-Based Services
• The Centers for Medicare and Medicaid Services (CMS) has proposed to reduce home health payments by
$350 million in FY 2016.
• This cut is in addition to sequestration and two years of payment reductions due to the rebasing of home health
payment rates.
• We ask that all Members of Congress tell CMS that a cut of this magnitude puts beneficiary access to care at
risk and exceeds the statutory limits Congress placed on rebasing home health payment rates.
2. Cosponsor the Home Health Documentation and Program Improvement Act of 2015 (S.1650)
• Introduced by Sens. Robert Menendez (D-NJ) and Pat Roberts (R-KS), this legislation provides common-sense
improvements to currently unworkable and administratively burdensome rules regarding Medicare home
health “face-to-face” documentation requirements.
3. Cosponsor the Home Health Planning and Improvement Act (S. 578)
• Introduced by Sens. Susan Collins (R-ME) and Charles Schumer (D-NY), this legislation would allow nurse
practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants, to order home health
services under Medicare in accordance with state law.
• This legislation would improve access to important home health care services, and potentially prevent
additional hospital and nursing home admissions.
HOSPICE
1. Cosponsor the Care Planning Act of 2015 (S.1549)
• This bipartisan legislation would establish Medicare reimbursement for healthcare professionals to provide
a voluntary discussion about the goals and treatment options for individuals with serious illness, resulting in
a documented care plan that reflects the informed choices made by patients in consultation with members of
their health care team, faith leaders, family members and friends.
• This legislation also provides resources for public and professional education materials about care planning.
2. Sponsor a Senate version of the Palliative Care & Hospice Education and Training Act (PCHETA)
• This legislation would establish education centers and career incentive awards to improve the training of
doctors, nurses, physician assistants, social workers and other health professionals in palliative care.
• This legislation (H.R. 3119) has been introduced in the House by Reps. Eliot Engel (D-NY), Tom Reed (R-NY)
and Emanuel Cleaver (D-MO).
SENATE PRIORITIES

9. 92015 PUBLIC P OLICY LEADERSHIP CONFERENCE
HOUSE PRIORITIES
Members of the House of Representatives and their staff need to hear directly from home health and hospice agencies
about the issues that will impact beneficiaries and providers in their district. Listed below are key time-sensitive
messages to share with your Representative’s office. You are welcome to use these messages—or put them in your own
words. This resource is intended to support you in your conversations with the Representative and his or her staff. In a
separate folder, we have provided additional information on each of these messages that you can give to the offices
for their reference.
HOME HEALTH
1. Protect and Preserve Access to Home-Based Services
• The Centers for Medicare and Medicaid Services (CMS) has proposed to reduce home health payments by
$350 million in FY 2016.
• This cut is in addition to sequestration and two years of payment reductions due to the rebasing of home health
payment rates.
• We ask that all Members of Congress to tell CMS that a cut of this magnitude puts beneficiary access to care
at risk and exceeds the statutory limits Congress placed on rebasing home health payment rates.
2. Cosponsor Home Health Planning and Improvement Act (H.R. 1342)
• This bipartisan bill would allow nurse practitioners, clinical nurse specialists, certified nurse midwives, and
physician assistants, to order home health services under Medicare in accordance with state law.
• This legislation would improve access to important home health care services, and potentially prevent
additional hospital and nursing home admissions.
HOSPICE
1. Cosponsor the Palliative Care & Hospice Education and Training Act (PCHETA) (H.R. 3119)
• This legislation would establish education centers and career incentive awards to improve the training of
doctors, nurses, physician assistants, social workers and other health professionals in palliative care.

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11. 112015 PUBLIC P OLICY LEADERSHIP CONFERENCE
PROTECT AN D PR ESERV E ACC ES S
TO HO ME-BA SED SERVICES
The Visiting Nurse Associations of America (VNAA) urges Members of Congress to protect beneficiary access to
home-based care by telling the Centers for Medicare and Medicaid Services (CMS) to stop proposed cuts to home
health payments. CMS intends to reduce home health payments by $350 million in FY16. This cut is in addition to
sequestration and two years of payment reductions due to the rebasing of home health payment rates.
VNAA urges all Members of Congress to tell CMS that a cut of this magnitude puts beneficiary access
to care at risk and exceeds the statutory limits Congress placed on rebasing home health payment
rates.
BACKGROUND
On July 6, 2015, CMS issued a proposed rule that would cut Medicare payments to home health agencies by $350
million in 2016. Current law requires CMS to “rebase” home health payment rate over four years (2014-2017) to
“better align” payments with costs. In implementing this policy, CMS may not reduce home health payments by more
than 3.5 percent per year over the four-year transition. As expected in the FY16 rule, CMS rule proposes to fully
implement the 3.5 percent rebasing cut in 2016.
Alarmingly, CMS also proposes to make an additional cut on top of rebasing. CMS reported that the average case
mix—or payment adjustment for the increased costs of treating higher-need patients—for home health agencies has
increased steadily. According to CMS, the case mix increase was due to home health agencies inappropriately
“upcoding” rather than actual changes in patient severity. To account for this, CMS is proposing to reduce home health
payments by an additional 1.72 percent in both 2016 and 2017. However, patient severity is already one of the factors
used to determine the rebasing adjustment. In other words, CMS is attempting to further rebase payments through a cut
of another name. This proposed cut goes beyond the limits that Congress outlined in the law.
CMS’ calculation is also flawed. Specifically, CMS used data from 2000 and 2010 to develop its estimates. Analysis
using the data from the actual time period (2012-2014) shows that the level of payment changes that have occurred fall
well below increases that would be needed to demonstrate upcoding had occurred in the payment system.
WHY THESE CUTS PUT PATIENTS AND PROVIDERS AT RISK
• Mission-driven, home health agencies operate on slim margins. Any further cuts threaten their ability to continue
providing services to vulnerable beneficiaries.
• Home health agencies costs are predominantly workforce-related (unlike brick-and-mortar providers such as
hospitals and physicians). Cuts to home health payment rates are more likely to reduce available jobs, wages,
employee benefits, programs for patients, and potential innovation projects.
VNAA urges Congress to tell CMS to eliminate the inappropriate “case mix adjustments” and work to
ensure Medicare beneficiaries can continue to have access to high-quality, home health services.

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13. 132015 PUBLIC P OLICY LEADERSHIP CONFERENCE
HOME HEALTH DOCUMENTATION AND PRO G R AM
IMPROVEMENT ACT OF 2015 (S. 1650)
The Visiting Nurse Associations of America (VNAA) strongly supports the Home Health Documentation and Program
Improvement Act of 2015 (S.1650). This bill was introduced by Sens. Robert Menendez (D-NJ) and Pat Roberts (R-KS).
This legislation provides common-sense improvements to currently unworkable and administratively burdensome rules
regarding Medicare home health “face-to-face” documentation requirements. The legislation also provides relief from
past claims denials and improves the approach the Centers for Medicare and Medicaid Services (CMS) uses to collect
evidence that beneficiaries are eligible for home health services moving forward.
VNAA urges all Senators to cosponsor this critical, bipartisan legislation that will help ensure
home health agencies can continue to provide physician-ordered, medically necessary services to
beneficiaries in their homes without fear of inappropriate denial of payment.
BACKGROUND
Due to recent regulatory changes, home health agencies are frequently denied payment due to poorly designed and
frequently misunderstood Medicare documentation requirements. Current law requires a physician to document that
a face-to-face encounter between an authorized provider and a beneficiary occurred in order to certify eligibility for
home health services. This provision is intended to ensure that beneficiaries are being referred to the most appropriate
care setting and to reduce the potential for waste, fraud and abuse within the home health benefit. Unfortunately, the
implementation of the requirement has resulted in negative unintended consequences for providers and beneficiaries
and has resulted in an unprecedented level of home health claim denials and a significant backlog of appeals. VNAA
estimates the number of claims pending appeals to be in the tens of thousands.
Face-to-face claim denials are often overturned on appeal. In the meantime, unpaid claims for care that is medically
necessary and appropriate make it hard for home health agencies to meet payroll and keep their doors open.
WHY THIS LEGISLATION IS CRITICAL TO PATIENTS AND PROVIDERS
• Significantly relieves the paperwork and regulatory burden on home health agencies, and reduces the risk of
inappropriate denials of care;
• Requires CMS to develop a standardized form (in consultation with stakeholders) that can be used to document a
beneficiary’s eligibility for home health services;
• Requires CMS to accept forms completed by the home health agencies that are reviewed and signed by the
referring physician;
• Exempts home health agencies from collecting documentation for beneficiaries who have been discharged from a
hospital or skilled nursing facility within 14 days prior to the initiation of such home health services;
• Requires contractor education to ensure fair and uniform application of the policy nationwide;
• Provides a mechanism for home health agencies to resubmit claims that were denied solely due to the currently
unclear and unworkable face-to-face documentation rules; and
• Requires a study of audit contractor performance on Medicare documentation for home health services and denial
and appeal rates.
VNAA urges Senators to cosponsor this important legislation to ameliorate the negative and
unintended consequences of the face-to-face requirement. Swift passage of this bill will ensure that
home health agencies can focus their resources on providing medically necessary care to beneficiaries
in their homes, and not fighting paperwork appeals.

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15. 152015 PUBLIC P OLICY LEADERSHIP CONFERENCE
HOME HEALTH CA RE PL A N N I NG I M PROVEMENT
ACT OF 2015 (S. 578 / H.R. 1342)
The Visiting Nurse Associations of America (VNAA) urges Members of Congress to cosponsor the Home Health
Planning and Improvement Act of 2015 (S. 578/H.R. 1342). This bill was introduced by Sens. Susan Collins (R-ME)
and Charles Schumer (D-NY) and Reps. Greg Walden (R-OR), Earl Blumenauer (D-OR), Mike Kelly (R-PA), Patrick
Tiberi (R-OH), Todd Young (R-IN), Lynn Jenkins (R-KS), Ron Kind (D-WI), Mike Thompson (D-CA), Danny Davis (D-IL),
Gregg Harper (R-MS), David McKinley (R-WV), Bill Johnson (R-OH), Janice Schakowsky (D-IL), Peter Welch (D-VT),
Lois Capps (D-CA), and Kurt Schrader (D-OR).
This legislation would allow nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician
assistants, to order home health services under Medicare in accordance with state law.
VNAA urges all Members of Congress to cosponsor this important legislation that will dramatically
improve access to home health services, and potentially prevent additional hospital and nursing
home admissions.
BACKGROUND
Physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives (otherwise known
as advanced practice registered nurses (APRNs) play a critical role in providing home care services to Medicare
beneficiaries, particularly in rural and underserved communities. While these providers are allowed to order nursing
home care and prescribe some medicines, they are not allowed to certify patients as needing or qualifying for home
health care. This legislation would improve access to Medicare home care services by allowing nurses and other
providers to certify Medicare patients for home health services.
WHY THIS LEGISLATION IS CRITICAL TO PATIENTS AND PROVIDERS
• Allows nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistants to order
home health services under Medicare in accordance with state law.
• Improves Medicare beneficiaries’ access to high-quality, Medicare home care services.
VNAA urges Congress to cosponsor this important legislation to allow advanced practice registered nurses to order
home health services for Medicare beneficiaries. Its timely passage will help Medicare beneficiaries across the
country, and in rural and underserved communities, access home health services.

17. 172015 PUBLIC P OLICY LEADERSHIP CONFERENCE
CARE PL ANNING ACT OF 2015
(S. 1549)
The Visiting Nurse Associations of America (VNAA) strongly supports the Care Planning Act of 2015 (S. 1549). This
legislation would ensure that patients with advanced illness receive extra support and care that reflects their wishes. The
bill was introduced by Sens. Mark Warner (D-VA) and Johnny Isakson (R-GA).
Specifically, the legislation provides Medicare coverage of voluntary, team-based discussions of prognosis and
care options for Medicare patients throughout the progression of advanced illness, not just at the end of life. The bill
requires that providers’ quality be evaluated based on whether the care provided aligns with the patient’s values. The
legislation also encourages the use and portability of advance directives across care settings and state lines.
VNAA urges all Senators to cosponsor this critical, bipartisan legislation that ensures Medicare
patients with advanced illness and at the end of life have access to better-coordinated and higher-
quality care.
BACKGROUND
Individuals with advanced illness, including those near the end of life, are frequently faced with difficult decisions
about treatment and medical care options. Today, patients often receive treatment for physical illness without adequate
consideration of emotional and spiritual health. Too often, caregivers must make decisions for their loved one when
the patient can no longer communicate and it can be devastating for everyone involved. Patients feel helpless and
burdensome; families worry that their choices may exacerbate their loved one’s suffering; providers know that they are
not providing the best care possible. Advanced care plans enable individuals to document their wishes while they are
still able to communicate for themselves.
WHY THIS LEGISLATION IS CRITICAL TO PATIENTS AND PROVIDERS
• Creates a Medicare benefit called Planning Services for those with serious or life-threatening illness that includes
team-based discussion of goals of care and values, explanation of disease progression, exploration of a relevant
range of treatment options, and a documented care values and preferences.
• Directs the Center for Medicare and Medicaid Innovation (CMMI) to conduct an Advanced Illness Coordination
Services demonstration, which will deliver wrap-around, home-based services to beneficiaries who need
assistance with two or more progressive disease-related activities of daily living.
• Directs HHS to develop quality measures that measure alignment between a patient’s goals, values and
preferences and the documented plan, treatment delivered, and outcomes.
• Provides grants to develop materials and maintain a website with information about advance care planning,
portable treatment orders, palliative care, hospice, and planning services.
• Requires health care facilities to assure that care plans made while an individual receives care are appropriately
documented prior to discharge and sent to appropriate providers and facilities.
VNAA urges Senators to cosponsor this important legislation to assist patients, families and
caregivers facing important choices at the end of life. When enacted, this legislation will help millions
of Medicare beneficiaries make advanced care plans that reflect their life and their choices—and give
them peace of mind and dignity.

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19. 192015 PUBLIC P OLICY LEADERSHIP CONFERENCE
PALL IATIVE CARE & H OS PI CE ED U CAT I O N AND
T R A I N I NG ACT (H.R. 3119)
The Visiting Nurse Associations of America (VNAA) strongly supports the Palliative Care & Hospice Education and
Training Act (PCHETA) (H.R. 3119). The bill was introduced by Reps. Eliot Engel (D-NY), Tom Reed (R-NY) and Emanuel
Cleaver (D-M0).
This legislation would establish education centers and career incentive awards to improve the training of doctors,
nurses, physician assistants, social workers and other health professionals in palliative care. PCHETA would also
strengthen clinical practice and improve health care delivery for patients living with serious illness, as well as their
families, by directing funding toward palliative care research. PCHETA would direct the implementation of a national
education and awareness campaign so that patients, families, and health professionals understand the essential role of
palliative care in ensuring high-quality care for individuals facing serious or life-threatening illness.
VNAA urges all Representatives to cosponsor this legislation to advance the practice of palliative care
and improve health care delivery for patients living with life-threatening diseases.
BACKGROUND
Palliative care improves quality, controls cost, and enhances patient and family satisfaction for the rapidly expanding
population of individuals with serious or life-threatening illness. The goal of palliative care is to prevent and relieve
suffering and to support the best possible quality of life for patients and their families, regardless of the stage of
the disease or treatment. It focuses on relief of the pain, symptoms, and stress of serious illness and on improving
communication with patients and families. Provided by a team of clinicians and specialists who work with the patient’s
regular physicians to provide an extra layer of support, palliative care is appropriate at any age and at any stage of
serious illness. It can be provided wherever a patient is seen, including in the patient’s home, and can be provided
together with curative treatment.
WHY THIS LEGISLATION IS CRITICAL TO PATIENTS AND PROVIDERS
• Establishes Palliative Care and Hospice Education Centers to improve the training of interdisciplinary health
professionals in palliative care; support continuing education; provide students with clinical training in appropriate
sites of care; and provide traineeships for advanced practice nurses.
• Implements fellowship programs within the new Palliative Care and Hospice Education Centers to provide short-
term intensive courses focused on palliative care. Supporting the team approach to palliative care, the fellowships
will provide supplemental training for faculty members in medical schools and other health professions schools,
including pharmacy, nursing, social work, chaplaincy and other allied health disciplines so providers who do
not have formal training in palliative care can upgrade their knowledge and skills for the care of individuals with
serious or life-threatening illness.
• Authorizes grants or contracts to schools of medicine, teaching hospitals and GME programs to train physicians
(including residents, trainees, and fellows) who plan to teach palliative medicine.
• Creates special preferences in existing nurse education law to include hospice and palliative nursing in education,
practice and quality grants, workforce development, and nurse retention projects. Also provides grants or contracts
for eligible health professionals who agree to teach or practice in the field of palliative care for at least five years.
VNAA urges all Representatives to support this important legislation which takes critical steps to
ensure our nation’s medical professionals have the necessary resources and training to provide high-
quality care to patients with advanced illness or at the end of life, and that patients and their families
are able to access needed palliative care.

20. H A R T S E N A T E
O F F I C E B U I L D I N G
U N I O N S T A T I O N
M E T R O

22. Visiting Nurse Associations of America
PUBLIC P OLICY LEADERSHIP CONFERENCE
2015 SP ONSORS