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11COMMONWEALTH OF PENNSYLVANIA2DEPARTMENT OF STATE3BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS45F I N A LM I N U T E S67MEETING OF:89STATE BOARD OF EXAMINERS OF10NURSING HOME ADMINISTRATORS1112TIME: 8:59 A.M.1314BOARD ROOM B15One Penn Center162601 North Third Street17Harrisburg, Pennsylvania171101819Wednesday, February 27, 2019202122232425Sargent's Court Reporting Service, Inc.(814) 536-8908
303132333435363738394041424344454647484950State Board of Examiners ofNursing Home AdministratorsFebruary 27, 2019BOARD MEMBERS:Kimberly D. Cobaugh, NHA, ChairpersonSharon K. McDermond, NHA, Vice ChairpersonAnne E. Holladay, CNHA, NHA, SecretaryIan J. Harlow, Commissioner of Professional andOccupational Affairs - AbsentDiane M. Baldi, R.N. - AbsentMichael P. Kelly, NHASara L. King, NHAAnna E. Stewart, R.N. - AbsentRobert L. Wernicki, NHASusan Y. Williamson, Department of Health designeeCarrie E. Wilson, Office of Attorney General, Bureauof Consumer Protection designee - AbsentBUREAU PERSONNEL:Judith Pachter Schulder, Esquire, Board CounselJ. Karl Geschwindt, Esquire, Board Prosecution LiaisonChris Stuckey, Board AdministratorKimberly Adams, Chief of Fiscal Management, Bureau ofFinance and OperationsShannon Boop, Fiscal Management Specialist, Bureau ofFinance and OperationsALSO PRESENT:Jacob Derrick, Policy Analyst, Governor’sPolicy & Planning OfficeKalonji Johnson, Policy Director, Department of StateKim Deline, Meeting & Marketing Manager, PennsylvaniaCoalition of Affiliated Healthcare & LivingCommunitiesBeth Greenberg, Senior Director of Regulatory Affairs,LeadingAge PAKelly Andrisano, Executive Director, PennsylvaniaCoalition of Affiliated Healthcare & LivingCommunitiesKate M. Routledge, Senior Director of ComplianceSupport, The Hospital and Healthsystem Associationof PennsylvaniaJanet Nerbecki, NHASargent's Court Reporting Service, Inc.(814) 536-8908
31***2State Board of Examiners of3Nursing Home Administrators4February 27, 20195***6The regularly scheduled meeting of the State7Board of Examiners of Nursing Home Administrators was8held on Wednesday, February 27, 2019.9Cobaugh, NHA, Chairperson, called the meeting to order10at 8:59 a.m.Kimberly D.Roll call was taken.11***12[Chris Stuckey, Board Administrator, reviewed the13emergency evacuation procedures for One Penn Center.]14***15Introduction of Audience16[Chairperson Cobaugh requested the introduction of17audience members.]18***19Approval of Minutes of the November 14, 2018 meeting20CHAIRPERSON COBAUGH:21Did everyone get a chance to review the22minutes of November 14, 2018?23Do I have a motion to approve?24MS. MCDERMOND:25I make a motion to approve.Sargent's Court Reporting Service, Inc.(814) 536-8908
41MS. HOLLADAY:23Second.CHAIRPERSON COBAUGH:45All in favor?[The motion carried unanimously.]6***7Report of Prosecutorial Division8[J. Karl Geschwindt, Esquire, Board Prosecution9Liaison, presented the Consent Agreement for File No.1017-62-11220.]111213***Appointment - Bureau of Finance and Operations AnnualBudget Review Presentation14[Kimberly Adams, Chief of Fiscal Management, Bureau of15Finance and Operations, introduced herself and Shannon16Boop, Fiscal Management Specialist.17Ms. Adams addressed licensee population from a18revenue standpoint.She reviewed the licensee count19for FY 2018-2019 at 17,053 with the recent addition of206 licensees.21since FY 2016-2017 but down 42 from FY 2014-2015.22Ms. Adams provided a breakdown of revenueShe noted licensee counts were up 3523sources.She reviewed the biennial total with 99% of24revenue from renewals and applications.25last fee increase in 2006.She noted theSargent's Court Reporting Service, Inc.(814) 536-8908
51Ms. Adams addressed the expense portion of the2budget.3the current FY 2018-2019 budget with the expenses.4She commented that expenses are based on direct costs5derived from timesheets and licensee-based fees.6She reviewed FY 2016-2017, FY 2017-2018, andMs. Adams discussed revenues and expenses from FY72016-2017, FY 2017-2018, and FY 2018-2019, and noted8the current balance.9expenses.She noted fund growth covering10Ms. Adams provided a breakdown of Board member11expenses for FY 2016-2017 and FY 2017-2018, noting the12budgeted amount for FY 2018-2019.13expenses as of February 6, 2019.14the Board did not use more than half of its15amount in FY 2018-2019, FY 2019-2020 was lowered in16half, dropping the budgeted amount from 24,000 to17 12,000. She commented that any excess balance in the18Board’s account would go back into the restricted19count and could only be used by the Board.She noted theShe stated, becausebudgeted20Ms. Adams reviewed the expenditure sheet21providing a pictorial view of the fluctuation in22expenses since the Board’s last fee increase in 2006.]23***24[Michael P. Kelly, NHA, exited the meeting at259:15 a.m. for recusal purposes.]Sargent's Court Reporting Service, Inc.(814) 536-8908
61***2Appointment – Julia Lynn Gregory3[Julia Lynn Gregory, addressed the Board regarding a4request to retake her examination.5informed the Board about recently taken courses that6she took including CPR, PharMerica, Pennsylvania7Health Care Association courses, Marywood University8refresher courses, Centers for Medicare and Medicaid9Services Emergency Preparedness Rule, Madonna10111213Ms. GregoryUniversity courses, and PharmScript.Ms. Gregory answered questions from the Boardrelated to her ability to test.Janet Nerbecki, NHA, stated Ms. Gregory was14studying constantly and will be reviewing the National15Association of Long-Term Care Administrator Boards16(NAB) information online.17Gregory will be more involved with the budget.18stated a three- to four-month time frame was realistic19for Ms. Gregory to have more exposure to the budget20process and review questions.]21She also noted that Ms.***22[Michael P. Kelly, NHA, reentered the meeting at239:34 a.m.]2425She***Report of Board CounselSargent's Court Reporting Service, Inc.(814) 536-8908
71[Judith Pachter Schulder, Esquire, Board Counsel,2updated the Board regarding 16A-6219 relating to3continuing education.]4***5Report of Board Chairperson6[Kimberly Cobaugh, NHA, Chairperson, addressed the7flat budget for long-term care from the Governor this8year.9drafting a letter noting concerns for long-term care10facilities to the office that deals with the budget.11She suggested some type of advocacy andChairperson Cobaugh stated no increase in the12government budget was a crisis in facilities and in13the realm of reimbursement from the state for the14Medicaid and Community HealthChoices (CHC) population.15Ms. McDermond questioned whether the Board had16done any kind of advocacy concerning running a17facility or challenges faced as a profession.18noted challenges every year with budget cuts,19especially when trying to care for Medicaid residents.20She commented that the Medicaid population was21growing, where there was no Medicare or the private22payment.SheMedicaid is a state-run funded program.23Ms. McDermond addressed federal involvement,24where the federal government provides states buckets25of Medicaid Medical Assistance monies with the issueSargent's Court Reporting Service, Inc.(814) 536-8908
81being that it needs to be used for the right groups of2people.3was advocating for increases in funding for long-term4care.5She noted that from a state perspective, itMs. Pachter Schulder noted that facility6reimbursement would not be an7Board’s bailiwick.891011issue within theMs. King addressed federal reporting, whereeverything is reported to the federal government thatimplements the five-star rating for facilities.Ms. King explained that it is both a national and12state issue, especially when there is no funding for13that particular population because the workforce is14part of the money received for Medicaid.15Jacob (Jake) Derrick, Policy Analyst, Office of16PA Governor Tom Wolf offered to connect the Board with17the person in the Policy Office who deals with all18Medicaid health issues to discuss the Board’s19concerns.]20***21Appointment – Governor’s Policy Office Presentation22[Mr. Derrick23decision to decrease the amount of continuing24education necessary to biannually renew a license from2548 hours to 36 hours.noted his appreciation for the Board’sMr. Derrick stated aSargent's Court Reporting Service, Inc.(814) 536-8908
91preliminary draft of the regulation had been sent to2the Governor’s Office, where Policy had signed off.3He stated the Office of General Counsel (OGC) would4review for legality.5[Ms. Pachter Schulder reviewed the regulatory review6process including interdepartmental review, review by7the Office of General Counsel the Office of General8Counsel, Budget and Policy followed by review by the9Office of Attorney General for about 30 days for their10review.She projected that it is possible that the11proposed regulation could be12early summer.published in late or13With regard to a statutory change deleting high14school eligibility for licensure, Mr. Derrick noted15the draft of the statutory language increasing16education from a high school diploma up to a two-year17degree, was submitted to the stakeholders, including18PACAH, LeadingAge, and The Hospital and Healthsystem19Association of Pennsylvania.20considered and incorporated.21Mr. DerrickTheirfeedback wasexplained that there would need a22sponsor, the legislation introduced, and then go23through the legislative process.2425Ms. Pachter Schulder referred the Board todraftlanguage Section 6(e) and (f) of the Speech-LanguageSargent's Court Reporting Service, Inc.(814) 536-8908
101Pathologists and Audiologists Licensure Act which2relates to having a high school diploma or equivalent,3so the requirements would be at least two years of4college-level study after secondary school study in an5accredited institution.6hold a bachelor’s degree in a nursing home7administration field would have to take the 120-hour8course.9She stated those who do notMs. Pachter Schulder directed the Board’s10attention to the letter from Beth Greenberg, Sr.11Director, Regulatory Affairs, LeadingAge PA requesting12an exemption for a registered nurses (RN) who hold a13certificate and those NHA students currently in the14process of becoming an NHA from the two year of15college study requirement.16Ms. Pachter Schulder addressed the letter from17HAP, who recommended a change from “at least two years18of college level study after secondary school” to “has19successfully complete an associate’s degree (AD) in a20related field.”21language would make diploma RNs ineligible.22that if the Board has the requirement for an AD and23then adds a carve out for RNs,24eligible for licensure.25She explained that the AD onlyShe noteddiploma RNs would beThe Board discussed that if the statute requiredSargent's Court Reporting Service, Inc.(814) 536-8908
111an AD rather than at least two years, somebody who2goes to school for three years and does not get a3degree would not meet that requirement unless the4person was.5Ms. McDermond questioned whether the related6field is clearly identified, noting that HAP’s comment7states “has successfully completed an associate’s8degree in a related field from an accredited9institution of higher learning.”10Ms. Stuckey explained the current regulations are11written as two years of college level and does state12it needs to be in a specific area.13master’s degree has to be a master’s degree in nursing14home administration or healthcare administration.15stated that a bachelor’s degree can be any bachelor’s16or if you have a bachelor’s in nursing home17administration or healthcare administration, then the18applicant is not required to take the 120-hour program19because the belief is that the training in a 120-hour20program would be addressed in the bachelor’s program21and the two years of college-level has never needed to22be in a certain area.232425She noted that theFollowing discussion, the Board endorsed anSheRNcarve out.Ms. Pachter Schulder suggested the Board decideSargent's Court Reporting Service, Inc.(814) 536-8908
121whether a degree will need to be attained or just a2minimum of two years of education before deciding3whether a related field is needed or not.4Ms. King commented that the bar needs to be5elevated to a minimum of an associate’s degree.6Ms. Williamson noted her concern regarding7workforce development and decreasing the pool.8suggested considering the administrator-in-training9program and teach those interested in this field.101112SheMs. King discussed RN tuition reimbursementprograms and agreed the bar should be raised.Ms. McDermond suggested advocating for the13profession as a Board and working with PACAH and14LeadingAge PA and promoting AIT programs and grants15that companies and facilities can get to cover costs16to have AITs in place.17through NAB and an immerging leaders event coming up18in July, which would be a great opportunity for AITs.19Mr. Derrick questioned whether someone without anShe mentioned a program20associate’s degree but two years of schooling could21petition the Board for a heightened level of scrutiny.22Ms. Stuckey explained that it would be similar to23those with high school diplomas.She commented that24the Board would have people coming in with two years25of college but no degree.Sargent's Court Reporting Service, Inc.(814) 536-8908
131Following discussion, the Board recommended that2Section 6(c) regarding qualifications for admission to3examination, would be changed from “at least two years4of college study” to “an associate’s degree; Section56(d) would state associate’s degree; Section 6(d)6would be unchanged; and Section 6(e) would raise the7amount of practical experience from one year to two8years for9associate’s degree but someone who has two years of1011candidates who applies in lieu of having ancollege.Kalonji Johnson, Policy Director, PA Department12of State, indicated that he was willing to conduct a13listening tour in various parts of the state to obtain14licensees’ thoughts on the continuing education15reduction, the courses that licensees lake and what16courses licensees believe should be required.17Ms. McDermond was on former Governor Corbett’s18Long-Term Care Commission and envisioned being at19different places based on the previous listening tour.202122Chairperson Cobaugh noted some negative articlesregarding the change.Mr. Johnson envisioned the tour as an opportunity23for outreach and to provide public education in an24off-site discussion, where the Board would decide25whether to participate.Sargent's Court Reporting Service, Inc.(814) 536-8908
141Ms. McDermond noted trepidation about having a2public forum and suggested the Board offer a3presentation or a Q&A session.456Mr. Johnson suggested a listening tour in theeastern and western half of the state.Ms. Pachter Schulder noted that the agenda for7the listening tour would be regarding decreasing the8continuing education requirement.9Mr. Johnson noted the listening tour to be a10community discussion and would not hold the Board to11any standards of participation.12an open request for the public to have a robust13discussion regarding continuing education.He noted publishing14Beth Greenberg, Senior Director of Regulatory15Affairs, LeadingAge PA, noted a conference in June and16suggested a webinar with Q&A ability.17Kelly Andrisano, Executive Director, Pennsylvania18Coalition of Affiliated Healthcare & Living19Communities, supported the listening session to be20sure fellow administrators agree with the position to21avoid unknown backlash.22Ms. King agreed with the idea of a webinar that23could be broadcasted through the different entities to24nursing home administrators throughout the state.25Kate M. Routledge, Senior Director of ComplianceSargent's Court Reporting Service, Inc.(814) 536-8908
151Support, the Hospital and Healthsystem Association of2Pennsylvania, provided information to Mr. Johnson3regarding an area in Pittsburgh for the listening4tour.5Ms. Routledge stated HAP was holding a6videoconference on April 26, 2019, and would be7another avenue to cover from the east and west.891011Mr. Johnson noted the Board’s participation inthe webinar and will obtain the dates for theconferences in April and June.Ms. Pachter Schulder addressed the request for12advocacy on behalf of nursing home administrator13profession, and noted that the Board could request14that the director of communications consider promoting15the nursing home administratorprofession.16 Mr. Johnson will contact the director of17 communications to find out what is available for the18 Board.19Ms. Holladay questioned whether PACAH, HAP, or20LeadingAge had a repository for administrators or21facilities that are promoting even an unpaid22internship.23not but could if there was an interest.24talk with her Board about putting one on their website25and including it in publications.Ms. Andrisano commented that PACAH doesShe agreed toSargent's Court Reporting Service, Inc.(814) 536-8908
161Ms. Pachter Schulder noted providing information2on the Board’s website for individuals looking for an3AIT to contact individual nursing homes or4associations representing nursing homes.5Ms. Greenberg noted a job board at LeadingAge PA,6but she did not know if AIT positions are posted.7noted frustration of not knowing where to send8individuals interested in an AIT program.9noted a scholarship program established for AITs.10She alsoMs. Holladay suggested obtaining information from11attendees to generate a list of administrators and12facilities at upcoming conferences to see if they13would be willing to host an AIT.]1415She****MS. PACHTER SCHULDER:16In the interim, when the Board did not17meet, you did have requests for18temporary permit applications for three19individuals: Michael A. Montes, Rebecca20Heimbach, and Tynisha Herder-Duncan.21Is there a motion to ratify the22approval of the temporary permit23application for each of those24individuals?25MS. MCDERMOND:Sargent's Court Reporting Service, Inc.(814) 536-8908
1712I make a motion.MR. WERNICKI:34I’ll second.CHAIRPERSON COBAUGH:56All in favor?[The motion carried unanimously.]78***Report of Board Administrator – No Report910***Report of Board Members1112***Report of Committees – No Report13***14New Business – Election of Officers15MS. PACHTER SCHULDER:16Is there a motion to name a Chair for17the Board?18the officers remain the same.19MR. KELLY:2021You can make a motion thatI make that motion.MS. PACHTER SCHULDER:22We have a motion for the officers to23remain the same as they are this year.2425Is there a second?MS. KING:Sargent's Court Reporting Service, Inc.(814) 536-8908
1812I second.CHAIRPERSON COBAUGH:3Are the officers currently willing to4continue on?5in favor?6I am hearing yeses.Opposed?Abstentions?[The motion carried unanimously.]7***8Miscellaneous – Board Meeting Dates9[Judith Pachter Schulder, Esquire, Board Counsel,10Allnoted the tentative 2020 Board meeting dates.]11***12 [Pursuant to Section 708(a)(5) of the Sunshine Act, at13 10:43 a.m. the Board entered into Executive Session14 with Judith Pachter Schulder, Esquire, Board Counsel,15 for the purpose of conducting quasi-judicial16 deliberations and to receive legal advice.The Board17 returned to open session at 11 a.m.]18***19MOTIONS20MS. PACHTER SCHULDER:21In executive session, the Board engaged22in quasi-judicial deliberations on the23consent agreement that is on the Board’s24agenda today.25Is there a motion to adopt theSargent's Court Reporting Service, Inc.(814) 536-8908
191Consent Agreement in File No. 17-62-211220?3MS. HOLLADAY:45So moved.MR. WERNICKI:67Second.CHAIRPERSON COBAUGH:8910All in favor?[The motion carried unanimously.name is Lisa Cherry, NHA.]1112The Respondent’s***MS. PACHTER SCHULDER:13Is there a motion to approve the Request14to Retake the Examination of Julia Lynn15Gregory upon receipt from her, no16earlier than 30 days from the date of17this meeting, a letter certifying that18she has received and reviewed19information and education on the NAB20study material for the current21examination as well as financing, for22which member Kelly has recused?23MS. MCDERMOND:2425I make a motion.MS. KING:Sargent's Court Reporting Service, Inc.(814) 536-8908
2012Second.CHAIRPERSON COBAUGH:3All in favor?4[The motion carried.5deliberations and voting on the motion.]6Mr. Kelly recused himself from***7[Judith Pachter Schulder, Esquire, Board Counsel,8noted the Board’s interest in making a motion for two9members to go to the National Association of Long-Term10Care Administrator Boards (NAB).11place the matter on the May agenda for further12discussion.]13Ms. Stuckey will***14Security Training Presentation15[The Board reviewed the security ERSON COBUGH:2021Do we have a motion to adjourn?MS. HOLLADAY:2223Motion.CHAIRPERSON COBUGH:2425Second?MS. KING:Sargent's Court Reporting Service, Inc.(814) 536-8908
211234Second.CHAIRPERSON COBAUGH:We are done.[The motion carried unanimously.]5***6[There being no further business, the State Board of7Examiners of Nursing Home Administrators Meeting8adjourned at 11:11 a.m.]9***1011CERTIFICATE1213I hereby certify that the foregoing summary14minutes of the State Board of Examiners of Nursing15Home Administrators, was reduced to writing by me or16under my supervision, and that the minutes accurately17summarize the substance of the State Board of18Examiners of Nursing Home Administrators meeting.19202122Amber Garbinski,23Minute Clerk24Sargent’s Court Reporting25Service, Inc.Sargent's Court Reporting Service, Inc.(814) 536-8908
9303132333435363738394041424344454647484950STATE BOARD OF EXAMINERS OFNURSING HOME ADMINISTRATORSREFERENCE INDEXFebruary 27, 2019TIMEAGENDA8:59Official Call to Order9:00Roll Call9:01Approval of Minutes9:01Report of Prosecutorial Division9:04Appointment – Bureau of Finance andOperations Annual Budget ReviewPresentation9:15Appointment – Julia Lynn Gregory9:32Report of Board Chairperson9:43Appointment – Governor’s Policy OfficePresentation10:40New Business10:42Miscellaneous10:4311:00Executive SessionReturn to Open Session11:00Motions11:11AdjournmentSargent's Court Reporting Service, Inc.(814) 536-8908
9 Services Emergency Preparedness Rule, Madonna 10 University courses, and PharmScript. 11 Ms. Gregory answered questions from the Board 12 related to her ability to test. 13 Janet Nerbecki, NHA, stated Ms. Gregory was 14 studying constantly and will be reviewing the National 15 Association of Long-Term Care Administrator Boards
