2021 Nebraska Association For Home ...

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2021 Nebraska Association For Home ...
2021
Nebraska Association for Home
    Healthcare & Hospice
Industry Partner Virtual Expo
              &
  Virtual Annual Conference

                          January 20-21, 2021
                          Attendee Registration
                           Virtual Conference
    An application for Contact Hours has been submitted to the Iowa Western
    Community College Board of Nursing Provider #6 and is pending approval.

                                                  Click Here To
                                                 Register Online
2021 Nebraska Association For Home ...
2021 Nebraska Association for Home Healthcare and
                   Hospice Virtual Networking Reception

            January 20, 2021 from 5:30 – 6:30 p.m. CST via Zoom

Building a relationship with your state senator and advocating on behalf of your clients is
increasingly important, as the healthcare environment continues to change, and the ability
to deliver home care and hospice services becomes increasingly challenging. Please join us
to discuss Medicaid home health reimbursement rates; personal care home care services
and requirements; the need for expanded use and reimbursement of telehealth services; the
Heritage Health Medicaid managed care program; and expansion of access of healthcare
services for our state’s citizens. A free webinar on Thursday, January 14, 2021 will be
held at 12:00 p.m. CST / 11:00 a.m. MST to help you prepare for the Virtual Networking
Reception with state senators. If you are unable to attend the live webinar, you can request
a recording. Please mark that option on the registration form.
2021 Nebraska Association For Home ...
Annual Conference Schedule
           Home Health Track                Hospice Track                Private Duty Track

Thursday, January 14, 2021 - Legislative Day Preparation
12:00 p.m. CST / 11:00   LLegislative Day Preparation Live Webinar
a.m. MST
Wednesday, January 20, 2021 - Annual Conference
   1:00 pm - 3:45 pm      Pre-Conference Session Home Health Regulation, Operations, and Payment
                          Updates! presented by Annette Lee
  4:00 pm - 5:00 pm       Industry Partner Expo (Live Chat with Exhibitors)

   5:30 pm - 6:30 pm      Virtual Networking Reception with State Senators
Thursday, January 21, 2021 - Annual Conference
   8:00 am - 8:05 am      Welcome and Announcements

  8:05 am - 10:05 am      Case Managment Across the Care Continuum presented by Diane Link

  10:05 am - 11:05 am     Virtual Exhibit Hall (Live Chat with Exhibitors)
  11:05 am - 12:05 pm     Roundtable Breakouts on Current and Emerging Topics Impacting the Home
                          Care and Hospice Industry

  12:05 pm - 12:15 pm                                        BREAK
  12:15 pm - 1:15 pm      Annual Business Meeting and Awards Presentations
   1:15 pm - 1:30 pm      Prize Drawings
   1:30 pm - 2:30 pm      Community Health: Key COVID-19 Considerations presented by Judy Riggert,
                          Amanda Holst and Kelly Mackling

   1:30 pm - 2:45 pm      Electronic Visit Verification Implementation Update and Q&A presented by
                          Nebraska DHHS Representatives Kathy Scheele and Karen Houseman; David
                          Centineo from Maxim Healthcare Services
  2:30 pm - 3:00 pm                                         BREAK
  2:45 pm - 3:15 pm                                         BREAK
  3:00 pm - 4:15 pm       Documentation Defensibility presented by Cindy Krafft and Dee Kornetti

   3:00 pm - 4:15 pm      Hospice Insights - presented by Katie Wehri from NAHC
    3:15 pm - 4:45 pm     Optimizing Caregiver Recruitment, Interview Strategies and Onboarding
                          presented by Nancy Allen
              4:15 pm     Evaluations/Q&A/Adjourn
2021 Nebraska Association For Home ...
Speakers
Annette Lee, RN, MS, HCS-D,                                   Diane Link, RN, MHA from
COS-C from Provider Insights,                                 Link Healthcare Advantage
Inc.DGM                                                       Diane Link is an RN with over 25 years
Annette is a registered nurse, with a                         of home health and hospice experience.
Master’s in Health Care Administration,                       Diane received her MHA from Mount
practicing since 1990, with the majority of                   St. Mary’s University and has a Green
her nursing experience in home health. For                    Belt in Lean Six Sigma. Her past roles
over a decade she worked with the CMS                         in home health and hospice include:
intermediary where she provided review of, and education      field nurse, PI nurse, clinical manager,
on home health and hospice documentation. Annette then        executive director of home health and hospice, accreditation
began providing outreach and provider education regarding     surveyor and clinical director for a major consulting
Medicare reimbursement issues and effective documentation     company. Diane is currently owner of her own consulting
strategies, assisting providers with ADRs and appeals.        agency - Link Healthcare Advantage. She is author of The
Today she marries together her experience in the “real        Hospice Guide to Quality Care and Reporting published by HC
world” and the inside knowledge of Medicare to ensure         Pro and is known for her industry regulatory knowledge and
providers can meet the requirements of CMS, and ensure        passionate presentation style.
compliant, efficient operations. She presents nationally
on the Conditions of Participation, (COPs), OASIS, PDGM,      Case Management Across the Care Continuum
HIS, LCDs, and documentation and coverage for both the        Identifying clear roles of the Home Health Case Manager
home health and hospice benefits. Annette holds both the      and Hospice Case Manager is critical. In this session,
Certificate for OASIS Specialist-Clinical and the Home Care
                                                              we will discuss their roles including assessment, visit
Coding Specialist-Diagnosis certification. She is an AHIMA
approved ICD-10-CM Coding Trainer.                            schedules, IDT updates, coordination of care, discharge
                                                              planning, developing and updating the care plan, critical
                                                              thinking and troubleshooting. We will discuss assessing
Home Health Regulation, Operations, and Payment               caregiver knowledge and willingness to participate in
Updates                                                       plan of care, education and communication for caregivers,
Join us for this session packed with tips and information     and preparing for a case conference.
to support your compliance with the Patient Driven
Groupings Model (PDGM), Request for Anticipated
Payment (RAP), Home Health Conditions of Participation        Roundtable Breakouts on Current and Emerging
(COPs), and avoiding denials for home health and hospice      Topics Impacting the Home Care and Hospice
claims. Review the trends seen in care planning, data, and    Industry
financials in the first year of PDGM. The regulations that    Bring your questions, ideas and information that you
mandate what must be completed by the clinician prior to      would like to share during these virtual networking
Request for Anticipated Payment (RAP) submission has          sessions via Zoom. Discussion questions include:
changed, but how has this changed your operations? Let’s      •   What is one change, innovation or new idea that
review some helpful hints to make sure you are making             you’ve implemented in the past year that might
the cut each time to avoid payment penalties. Review the          benefit fellow home care and hospice professionals in
COPs vs. the Conditions for Payment.                              caring for and serving patients?
Discuss the changes in the COPs due to the 1135 waivers       •   What is the biggest challenge or opportunity that you
and the COP survey protocols. Review the top 10 citations         are facing and how might the Nebraska Association
for 2019 and discuss what compliance looks like for each          for Home Healthcare and Hospice best support
of these areas. We will review the changes in medical             you as you advocate and address that challenge or
review due to the Public Health Emergency (PHE) and               opportunity?
the 1135 waivers. We also discuss the issues that CGS is
reviewing for home health and hospice claims, the top         •   How are you using telehealth and what have been the
5 denials in 2019 and strategies on how to avoid these            successes?
denials.                                                      •   Are you familiar with how state legislation impacts
                                                                  your patients and agency or company? What issues
                                                                  would you like to know more about?
2021 Nebraska Association For Home ...
Speakers
Judy Riggert, MS, RN                                           Kelly Mackling, RN, BSN
from the Visiting Nurse                                        from the Visiting Nurse
AssociationDGM                                                 AssociationDGM
Judy Riggert has served as                                     Kelly Mackling is Clinical Manager
Infection Preventionist for VNA                                of Physician Ordered Maternal Child
of the Midlands since 2011 under                               Homecare at the Visiting Nurse
the direction of the University                                Association. Kelly has worked at the
of Nebraska Medical Center,                                    Visiting Nurse Association for 20
College of Medicine Department of Internal Medicine, and       years. She started as a Nurse Case
Infectious Disease Medical Directors. Her clinical expertise   Manager making home visits with new moms and babies,
includes greater than 25 years of surgical and medical         and over the years, transferred into a management position.
intensive care, orthopedic & spine and rehabilitation          Kelly has a passion for working with young, vulnerable
management and more than 11 years of home care and             families, assuring they have the support and medical care
hospice services.                                              they need to raise healthy children.
                                                               Community Health: Key COVID-19 Considerations
Judy has completed the Infection Prevention Course for
Healthcare Providers by the Nebraska University Medical        Do your agency or organization’s infection control and
Center and Clarkson College and the Primary Infection          prevention practices need changes or enhancements?
Prevention Course: Long-Term Care Track as well as the         Come to this session prepared to discuss infection
CDC Nursing Home Infection Preventionist Training              prevention strategies based on evidence-based practice,
Course. She is responsible for the Infection Control &         federal and state guidelines, current CDC, OSHA and
Prevention policies, procedures, practices and consultation    CMS guidelines and actual experience. Learn about
and training for a large home care, hospice and palliative     actual experiences from a community-based healthcare
care program, acute and high risk maternal child programs,     organization.
clinical pharmacy, physical therapy clinic, Easter Seals
Nebraska, school nurse program and homeless and domestic
abuse shelters throughout the Omaha Nebraska and Council       Kathy Scheele from the
Bluffs Iowa areas.
                                                               Nebraska Department of
Amanda Holst, MS, CCC-                                         Health and Human Services
SLP from the Visiting                                          frGM
Nurse Association frGM                                         Kathy Scheele is an Administrator for
                                                               the Nebraska Department of Health and
Amanda is Vice President of
                                                               Human Services. She previously served
Home Health, leads the overall
                                                               as Medicaid Supervisor for City of Lincoln, Aging Partners.
operations of VNA Home Health,
                                                               Kathy’s professional experiences also include Administrator
and is responsible for the delivery
                                                               and Internship for Golden Living Centers in Nebraska City
of effective and efficient clinical
                                                               and Plattsmouth; Nursing Home Administrator, ELCA Good
services. Twenty years ago, as a new Speech-Language
                                                               Samaritan Society in Wymore, Nebraska and Lyons and
Pathologist (SLP) graduate, Amanda began working for
                                                               Liberal, Kansas; and Administrator, Community Care of
the VNA. She immediately fell in love with the VNA and
                                                               America in Milford, Nebraska.
the opportunities it presented, including the meaningful
relationships established with patients and their families,
                                                               Kathy earned a Bachelor of Science from the University
the compassionate and expert team members she worked
                                                               of Nebraska-Lincoln in Business Administration, Human
alongside of and the overall mission of the organization. In
                                                               Resource Management and an Associates Degree in Health
2004, Amanda’s career transitioned from direct patient care
                                                               Care Administration from Central Community College in
as an SLP to management and leadership serving in roles of
                                                               Hastings.
Clinical Manager of Rehabilitation Services and Director of
Home Health.
                                                               Karen Houseman from
Amanda resides in Avoca, Iowa with her husband Jason,
and two children Blake and Madison. Amanda’s family is         the Nebraska Department
kept busy with participating, coaching, and supporting         of Health and Human
a variety of sports activities within the community and
school district, with her team favorites being the AHSTW       ServicesGM
Vikings and Lady Vikes, Iowa Hawkeyes, and the Iowa State
Cyclones (when they aren’t playing the Hawkeyes).              Karen Houseman is Program Manager II
                                                               for the Nebraska Department for Health
                                                               and Human Services. Her responsibilities include serving as
                                                               the Policy Program Manager for the Aged and Disabled and
2021 Nebraska Association For Home ...
Speakers
Traumatic Brain Injury Waivers and serving on the Brain        opportunities and challenges is clearly evident in both
Injury Alliance Council. Karen also had Prior Program          training and consultation activities.
Manager duties for Personal Assistance Services, Program
of All-inclusive Care for the Elderly through April 2020.      For the past 15 years, Cindy has been a nationally
                                                               recognized educator in the areas of documentation,
Karen earned a Master of Science in Organizational             regulation, therapy utilization and OASIS. She has and
Management (MSOM) with Human Service Focus from                currently serves on multiple Technical Expert Panels with
Chadron State College, and earned a Bachelor of Arts in        CMS Contractors working on clinical and payment reforms
Psychology with minors in English and Communications           and bundled payment care initiatives. Her focus is on
from the University of Nebraska-Lincoln. Karen is the          providing the knowledge and tools critical to the post-acute
Founder and Community Contact for Near Oak Lake                continuum of care to operationalize external requirements
Neighborhood Association– founder and community contact        while keeping the driver of care where it needs to be – the
and is a Member of Toastmasters International.                 needs of each patient being cared for.

                                                               Cindy has been involved at the senior leadership level for
David Centineo from Maxim Healthcare                           the Home Health Section of the American Physical Therapy
ServicesDGM                                                    Association for more than 10 years and is the immediate
                                                               Past President of that organization. She is on the editorial
David Centineo earned a Bachelor of Science degree in          board of Home Healthcare Now and a frequently sought out
Psychology from Radford University. He is Senior Project       expert contributor for other home health publications.
Manager for Maxim Healthcare Services.
                                                               Cindy is an active member of the National Association of
David leads and manages large enterprise-level projects.       Home Care and Hospice (NAHC) and currently serves on
He supports key business leaders in managing customer          multiple committees. She has written 3 books – The How-to
expectations for project deliverables, managing stakeholder    Guide to Therapy Documentation, An Interdisciplinary Approach
communications, and leading the implementation of              to Home Care and the Handbook to Home Health Therapy
effective system and project governance. David manages         Documentation – and co-authored her fourth, The Post-Acute
project backlogs by gathering feedback, leveraging             Care Guide to Maintenance Therapy with her business partner
stakeholders and customers, and support teams. He              Diana Kornetti.
promotes empowerment of the team, ensuring each team
member is fully engaged in the project and making a
meaningful contribution, and encourage a sustainable pace      Dee Kornetti, PT, MA,
with high levels of quality.                                   HCS-D from Kornetti
Electronic Visit Verification Implementation Update
                                                               & Krafft Health Care
and Q&A                                                        SolutionsDGM
Learn the latest updates on what your agency, company
                                                               Dee, a physical therapist for 30 years,
or organization needs to do to comply with the Electronic      is a past administrator and co-owner
Visit Verification (EVV) requirements mandated by the          of a Medicare-certified home health
federal government. There will be a Q&A session at the         agency. Dee now provides training and
end to answer your questions and support your agency or        education to home health industry providers as Owner/
organization with successful implementation.                   Founder of a consulting business, Kornetti & Krafft Health
                                                               Care Solutions, with her business partners Cindy Krafft and
                                                               Sherry Teague.
Cindy Krafft, PT, MS,                                          Dee is nationally recognized as a speaker in the areas of
HCS-O from Kornetti                                            home care, standardized tests and measures in the field of
                                                               physical therapy, therapy training and staff development,
& Krafft Health Care                                           including OASIS, coding, and documentation, in the home
Solutions                                                      health arena. Dee is the current President of the American
                                                               Physical Therapy Association’s Home Health Section and
Cindy Krafft PT, MS, HCS-O                                     serves on the APTA’s national Post-Acute Work Group. She
brings more than 20 years of home                              serves as the President of the Association of Homecare
health expertise that ranges from                              Coding and Compliance, and a member of the Association
direct patient care to operational                             of Home Care Coders Advisory Board and Panel of Experts.
/ management issues as well as a                               She has served as a content expert for standard setting
passion for understanding regulations. Years spent in the      for Decision Health’s Board of Medical Specialty Coding
direct patient environment solidified that this was the        (BSMC) home care coding (HCS-D) and OASIS (HCS-O)
optimal setting for the provision of effective and efficient   credentialed exams. She holds current credentials in Home
interdisciplinary care as it focuses on functionality and      Health Coding (HCS-D) and Compliance (HCS-C) from this
patient centered care delivery. Recognition that providing     trade association. Dee is also on Medbridge’s Advisory
care in the home environment presents both unique              Board for development of educational content on its home
2021 Nebraska Association For Home ...
Speakers
health platform, and has authored several courses related to     requirements; updates to the hospice payment rates; key
OASIS, Conditions of Participation (CoPs) and therapy.           developments in the Hospice Quality Reporting Program;
                                                                 and the Medicare Advantage (MA)-VBID-Hospice
Dee is a published researcher. on the Berg Balance Scale,
and has co-authored APTA’s Home Health Section resources         demonstration. We will also discuss regulatory and
related to OASIS, goal writing and defensible documentation      legislative hot topics. Please bring any hospice-related
for the practicing therapist. Dee has contributed chapter        questions that you have for the Q&A at the end of the
updates to the Handbook of Home Health Care Administration       session.
6th edition, and co-authored a book, The Post-Acute Care Guide
to Maintenance Therapy published in 2015.

Dee received her B.S. in Physical Therapy from Boston
                                                                 Nancy Allen, BSN, RNC,
University’s Sargent College of Allied Health Professions,       CMC from Solutions for
and her M.A. from Rider University in Lawrenceville, NJ.
Her clinical focus has been in the area of gerontology and       Care, Inc.DGM
neurological disease rehabilitation.                             Nancy E. Allen, BSN, RNC, CMC, is
                                                                 Chief Executive Officer of Solutions
Documentation Defensibility in 2021 and Beyond                   for Care, Inc., a consulting company
Although the pandemic slowed the pace of external audit          specializing in community-based
scrutiny, the need to be “review ready” has not abated.          health care and care management.
Fundamental coverage and qualifying criteria as well             Her passion includes assisting
                                                                 providers to develop effective
as confirmation of skilled, reasonable and necessary             operations for compliance to deliver “quantifiable”,
have not changed. Based on extensive work with clients           outcome-driven patient care.
undergoing audits such as Targeted Probe and Educate
(TPE) as well as those battling in the appeals process for       Her many years of experience include clinical,
payment denials, this session will provide the framework         administrative, home care, and 10 years as a state and
of an efficient and effective way to ensure compliance is        accreditation surveyor. Nancy is certified as a Clinical
sufficient even in the midst of the every changing world         Specialist in home health, care management and as a
of home care.                                                    long-term care surveyor. She has served as a Corporate
                                                                 Integrity Monitor for the Office of Inspector General and
                                                                 as a Medicare Hearing Officer for the Centers for Medicare
                                                                 & Medicaid Services’ Medicare Fair Hearing Department,
Katie Wehri, RN, BSN                                             where she conducted and adjudicated federal administrative
from Home Care &                                                 hearings.
Hospice Regulatory                                               With a team from the University of Hawaii, Nancy serves
Affairs for the National                                         as an educator and consultant in the development of
                                                                 community-based health care in the Pacific islands of the
Association for Home                                             Republic of Palau and American Samoa.
Care HospiceDGM                                                  Nancy is a contributing author to the Handbook for Home
Katie Wehri is Director, Home Care & Hospice Regulatory          Health Administration and numerous other articles in
Affairs for the National Association for Home Care &             national and state healthcare publications. Her book,
Hospice (NAHC). She is responsible for development of            Survivor! Ten Practical Steps to Survey Survival has helped
new and enhancement of existing regulatory, operational          many achieve deficiency-free surveys.
and legislative resources. Katie’s professional experiences
include serving as Hospice Operations for NAHC; Director
of Operations Consulting for Healthcare Provider Solutions;      Optimizing Caregiver Recruitment, Interview
Hospice Liaison for the Indiana Association for Home             Strategies and Onboarding
Care and Hospice; and Owner and Consultant for Wehri &           Explore the current and future shortage of caregivers.
Associates.                                                      Effective recruitment techniques will be taught including
                                                                 operational analysis and avoiding common pitfalls. Learn
Katie earned a BSBA, Health Care Administration from             to identify the right attitudes and the ability to adapt to the
Bowling Green State University, Bowling Green, Ohio; and
                                                                 ever-changing environment of home care. The importance
earned a Specialization in Human Resource Management
MBA Coursework, University of Toledo, Toledo, Ohio               of written processes for standardization when onboarding
Specialization in Health Care Administration.                    a new hire will be discussed. Examine how to monitor the
                                                                 onboarding process to prevent loss of a new caregiver in the
                                                                 process. Learn how to create a mentoring culture to retain
Hospice Insights
                                                                 and promote the longevity of caregivers.
Learn the latest updates impacting hospice. This session
will cover the modified Medicare hospice election
statement criteria and election statement addendum
2021 Nebraska Association For Home ...
coverage eligibility under the Medicare Part A Home
                    Purpose Statement                                    Health benefit.
   The Nebraska Association for Home Healthcare and Hospice        18.   Define what “skilled, reasonable and necessary” means
 Annual Conference will bring together home care and hospice             for coverage of clinical services under the Medicare
 professionals to discuss current and emerging issues impacting          Part A Home Health benefit.
     the industry. This includes regulatory, compliance and        19.   Incorporate critical subjective and objective
  payment updates and onboarding and engaging employees to               information in clinical assessments to support Medicare
   deliver care and support for home care and hospice clients.           eligibility requirements.
                                                                   20.   Review the modified Medicare hospice election
             Conflict of Interest Statement                              statement and election statement addendum which
                                                                         were required to be implemented by hospices on
  The speakers have identified no actual, potential or perceived         October 1, 2020 and identify the requirements, impacts
   conflict of interest. The Nurse Planners have identified no           and strategies for incorporating the new documents
        actual, potential or perceived conflict of interest.             into the admission process.
                                                                   21.   Review the updates to the hospice payment rates for
                  Conference Objectives                                  2021 including wage index changes and aggregate cap.
                                                                   22.   Discuss the key developments in the Hospice Quality
1. Learners will be able to discuss how the home health                  Reporting Program.
    payment and clinical planning intersect, and the impact        23.   Discuss the focus and expected impacts of the MA-
    to payment in the first year.                                        VBID-Hospice demonstration that CMS will launch on
2. Learners will identify the updated RAP regulations and                January 1, 2021 and identify areas of focus for hospice
    how HHAs can fine tune their operations for efficient                providers.
    approach.                                                      24.   Review hospice regulatory and legislative hot topics.
3. Learners will be able to determine the top survey               25.   Understand the current and projected need of
    citations and discuss strategies to improve compliance.              caregivers in the future.
4. Learners will be able to discuss the medical review             26.   Demonstrate techniques to produce effective caregiver
    process and how to avoid the top 5 denials for medical               recruitment for an organization.
    review.                                                        27.   Describe interview strategies to hire quality staff.
5. Identify the role of the case manager in home health            28.   Identify best practice processes of onboarding into an
    and hospice.                                                         organization.
6. Identify the role of the case manager in developing an          29.   Demonstrate how to create a mentoring culture to
    interdisciplinary care plan.                                         retain caregivers.
7. Identify how to engage all care providers (family,
    private duty caregivers) in the interdisciplinary care
    plan.
8. Identify the role of case conferencing in patient                In order to receive contact hours for the conference,
    outcomes.                                                       you will be asked to complete a sign-in sheet,
9. Demonstrate one new idea or practice that you can                evaluation form and register your contact hours in the
    implement to enhance services and support for your              Iowa Western Community Board of Nursing portal. A
    clients.                                                        Certificate of Completion will be emailed to you after
10. Demonstrate how to advocate for a challenge or                  that documentation is received.
    opportunity impacting your agency or company, clients,
    or the home care and hospice industry.
11. Learn strategies for effective use of telehealth to serve
    clients.
12. Apply basic fundamental infection control/prevention
    practices in the home and community settings.
13. Describe policies and procedures necessary to help
    prevent transmission of COVID-19 amongst health care
    workers and patients.
14. Discuss the importance of effective collaboration and
    communication during the intake/screening and referral
    processes concerning COVID-19 between home health
    clinicians, patients, and caregivers.
15. Articulate how to adapt to the CDC guidelines at home
    pertaining to challenges experienced for COVID-19
    based on complex case studies across the lifespan.
16. Demonstrate the components needed to implement and
    use Electronic Visit Verification in Nebraska.
17. Discuss documentation requirements to support
2021 Nebraska Association For Home ...
Virtual Annual Conference Attendee Registration
 Thursday, January 14, 2021
 c $0                                                                       Legislative Day Preparation Live Webinar
 c $0                                                                       I am unable to attend the webinar, but would like to receive a
                                                                            recording.

 Wednesday, January 20, 2021
 c $0                                                                       Nebraska Association of Home Healthcare and Hospice Virtual
                                                                            Legislative Networking Reception with State Senators
 c $0                                                                       Industry Partner Expo (virtual event)

 c $0                                                                       Pre-Conference Session Home Health Regulation, Operations,
                                                                            and Payment Updates!

 Thursday, January 21, 2021
 c $170 (1st representative from your                                       Annual Conference Nebraska Association of Home Healthcare
   agency/organization/company)                                             and Hospice Member
 c $150 (each additional representative) x
 c $5 (each representative) x _____
   wanting contact hours (nursing CE) to be filed
   with the Iowa Western Community College Board of
   Nursing
 c $210 (1st representative from your                       Annual Conference Prospective Member
   agency/organization/company)
 c $190 (each additional representative) x
 c $5 (each representative) x
    wanting contact hours (nursing CE) to be filed with the
    Iowa Western Community College Board of Nursing

     Name(s) of Participant(s) and Credentials (if applicable):
1.                                                                   Email:
2.                                                                   Email:
3.                                                                   Email:
4.                                                                   Email:
5.                                                                   Email:                                                                  __________
Agency:                                                                                                                                     ___________
Address:                                              City:                                     State:               Zip:               ______________
Phone:                                             ____________________________________________________________________________

                                   Event Registrations must be received no later than January 14, 2021.
               Cancellation policy: A 50% fee refund will be given on cancellations submitted to the Nebraska Association of
                                         Home Healthcare and Hospice office by January 14, 2021.
                                     All refunds will be processed after accounts have been completed.

     Payment Methods
     p Check - Print this form, fill it out, and send to the Nebraska Association of Home Healthcare and Hospice with a check
       made payable to the Nebraska Association of Home Healthcare and Hospice, 3901 Normal Blvd., Ste. 100, Lincoln, NE 68506.
     p Credit Card - Click here to register/pay online.

When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account
or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from
your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution.
2021 Nebraska Association For Home ...
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