See below update from AHCA Chair Tom Coble:

Dear Colleagues:

It’s hard to believe it is already February! We jumped right into 2017 with its many opportunities and challenges. We had a very successful 2016, and with your continued efforts and perseverance, we will continue to offer solutions, improve lives and deliver quality care.

The AHCA Board of Governors recently held its first meeting of the year, and I hope you will find the summary below helpful.

Association & Washington Updates

AHCA/NCAL remained financially strong in 2016. I am pleased to report that we wrapped up the year significantly better than budget on operating expenses and revenues, and net assets remain strong. We had a tremendous year with many contributions to this success, including record-breaking attendance at the Annual Convention and Expo and a diligent staff that continues to serve as good stewards of our membership’s dues. Everyone played an important part – and for that, thank you.

AHCA/NCAL President and CEO Mark Parkinson reported that association membership continues to be strong. AHCA now represents two-thirds of nursing homes in the country. It is also exciting to share that we continue to see a significant increase in not for profit and assisted living growth.

2017 Strategic Plan and Priorities
The first 100 days of the Trump Administration will focus on confirmations, including Tom Price for Department of Health and Human Services (DHHS) Secretary and Seema Verma for Administrator of the Centers for Medicare and Medicaid Services (CMS). It will also focus on repealing the Affordable Care Act (ACA). As you know, AHCA met with the new Administration to present specific requests developed with member input and Board direction. We are pleased to have received this opportunity to share our concerns/requests and will keep you apprised of any updates.

We have several opportunities in 2017. The possibility of an ACA repeal may offer relief on fronts such as the employer mandate. AHCA shared its concerns with the new Administration about mandatory bundling programs, as well as the need to recognize observation days as part of the three-day stay.

We are also seeking an opportunity for survey relief. Civil monetary penalties increased dramatically over the last six months of 2016 – despite a decrease in deficiencies. We will work closely with CMS staff and leadership to make sure they understand what needs to be changed. Several AHCA Board members have already begun to meet with CMS staff to discuss the survey process and how we can work together to make improvements. Additionally, AHCA has grassroots efforts planned, including a Congressional fly-in on March 21 to visit Capitol Hill. We are asking members of Congress to put pressure on CMS over this issue. For more information or to participate in the fly-in, please contact Matt Smyth.


FY18 SNF Prospective Payment System (PPS) Rule
Recommendations from the Medicare Payment Advisory Commission (MedPAC) could threaten to cut our Medicare payments. Of note, neither Congress nor DHHS is required to act upon MedPAC recommendations. Senior Vice President of Reimbursement Policy Mike Cheek discussed the 2018 payment rule, noting that MedPAC is supportive of CMS’s efforts to reform the payment system and continues to take an aggressive approach with proposals to reduce Medicare post-acute care spending. There are many possibilities right now as to what could happen, and the AHCA staff and Board have presented our concerns to the Trump Administration. CMS issues our 2018 Payment Rule on May 1, and we are optimistic that we will succeed.

Medicaid Reform
We face many unknowns when it comes to Medicaid right now. Timing of reform efforts, the process under which reform may be introduced and passed in Congress, and options to protect the millions of residents and patients we serve – these all remain unclear. As I’ve noted previously, the Association has been very proactive in its efforts to protect Medicaid. Our members have met with members of Congress to share their concerns and expertise, as well as try to get answers. Furthermore, AHCA continues to work on a Medicaid strategy that includes coalition building, conducting analyses to identify which states could be negatively impacted by changes to the program, and developing tools for state affiliates that include steps they can take now to prepare for 2017. I will be sure to provide updates as we learn more.


We continue to pursue the arbitration litigation to challenge the provision in the requirements of participation that would ban pre-dispute arbitration agreements. On January 5, 2017, the Department of Justice (DOJ) appealed the preliminary injunction (PI) order to the U.S Court of Appeals for the Fifth Circuit. The federal government’s brief in that appeal is due on March 6, 2017, and AHCA/NCAL’s reply is due 30 days later.

Quality & Regulatory

Quality Cabinet Co-chair Mary Ousley shared several important quality and regulatory updates.

  • SNF Value Based Purchasing (VBP) imposes up to a 2 percent cut to Medicare Part A rates for one year based on your rehospitalization score, so now is the time to focus on reducing your rehospitalization rate.
  • We are continuing to work on the AHCA Quality Initiative goals. Please take time to review the customized “Your Top Line” report to understand your center’s progress. The next report is scheduled to be released at the end of February, and you can learn more here.
  • CMS has created an action group tasked with developing two quality measures to help AHCA members understand and measure unintended health care outcomes. More information will be shared on this in the coming months.
  • The number of Quality Award applications continues to grow at the gold and silver levels. The deadline to apply for this year’s awards passed in late January, and we had a record number of applications.
  • CMS is enacting the IMPACT Act through its SNF Quality Reporting Program (QRP). CMS must submit Measures Under Consideration (MUC) to the National Quality Foundation (NQF) Measure Applications Partnership (MAP) for review and comment. Last year, CMS submitted 12 SNF measures to MUC but proposed only four of them in the SNF 2017 notice of proposed rulemaking (NPRM). Some – or perhaps all – of the remaining eight may appear in the SNF 2018 NPRM. Three AHCA measures received endorsement by NQF in 2016, including:
    • Three Core Q measures for Short Stay and Long Stay.
    • Long Stay Hospitalizations.
    • Discharge to Community all payor.


NCAL Board Chair Chris Mason reported on 2016 membership growth and highlighted some of NCAL’s work in 2016.

  • Assisted living membership increased by more than 10 percent across the country, exceeding NCAL’s 2016 goal of 8 percent growth. Membership engagement also continues to grow through opportunities such as the Senior Living Executive Council (SLEC), which engaged 25 of the largest assisted living companies in the country last year.
  • NCAL continued to offer policy solutions. Co-chairs of the Senate Aging Committee wrote to CMS on the Home and Community-Based Services final rule and raised many of NCAL’s concerns. Additionally, NCAL released its State Regulatory Review in September, summarizing key state requirements for assisted living licensure or certification.
  • Our assisted living members strengthened their role as advocates for the profession. NCAL held two political events for key members of Congress in conjunction with SLEC meetings. Additionally, more assisted living providers met with key members of Congress during Congressional Briefing 2016 than ever before.
  • NCAL continues to lead on quality. We added four new assisted living measures to LTC Trend Tracker at Convention. Last year also saw the highest assisted living participation in the Quality Awards Program to-date.

Chris also discussed the 2017 NCAL Strategic Plan. NCAL will continue its efforts to advocate on behalf of the profession, increase membership engagement, provide solutions for quality care, and provide policy solutions.

Additional Board Actions

AHCA/NCAL Building
The AHCA/NCAL headquarters in Washington, D.C. is a valuable resource, and many real estate developers in the area understand this. Thus, we have been approached multiple times with offers to purchase the building. Following an in-depth discussion of pros and cons for various options, the Board approved a strategy for assessing future offers for sale of the building and space considerations for the AHCA/NCAL headquarters office. The strategy includes important factors such as criteria for offers to be considered by the Board, the importance of owning a headquarters building and having a D.C. presence, as well as a review of the current building for operational efficiencies and improvements.

2023 AHCA/NCAL Annual Convention and Expo
The Board approved hosting the 2023 AHCA/NCAL 74th Annual Convention and Expo in Denver, Colorado. I hope many of you will join us for this year’s 68th Annual Convention and Expo October 15-18 in Las Vegas, Nevada. Look for more information on the AHCA website in early April.


We have a busy and exciting year ahead. There are challenges, but there are also many opportunities. As long as we continue to work together and stay the course, I am confident that we will accomplish much good for our patients, residents, providers, caregivers, and families.

I encourage you to take advantage of the upcoming opportunities to collaborate with, educate, and learn from your peers. Join us at the 2nd Annual AHCA/NCAL Quality Summit in Orlando March 6-8 and the Independent Owner Leadership Conference, also in Orlando, March 8-10. We also have several opportunities to make your voice heard on Capitol Hill. In addition to the March 21 fly-in focused on survey relief (contact Matt Smyth for more information), AHCA’s Intellectual and Developmental Disabilities Residential Services Providers annual Hill Fly-In event will occur on March 22. Contact Dana Halvorson with any questions or to register. Finally, AHCA/NCAL will host its annual Congressional Briefing June 5-6 at the Hyatt Regency Washington.

I look forward to seeing you at these great events and working with you in the months ahead.

Best regards,

Tom Coble
Chair, AHCA Board of Governors

If you have any questions or concerns, please contact Julie Painter, Vice President of Constituency Affairs & Governance.