2018 AHCA/NCAL Annual Convention

INT-1 (r) - Replacing RUGs – CMS’ New SNF Payment System & How to Get Ready

Wednesday, October 10
10:30 AM - 3:30 PM
CE: NAB: 0 | Nurses 0

NOTE: The PDPM intensive sessions will be open to all convention attendees who have purchased a Sunday Only, Wednesday Only, Full or Premium meeting package possessing an Attendee, Sunday or Wednesday badge. All other badge holders will not be given access. Access to PDPM proprietary tools will be provided via e-mail to SNF provider members only via e-mail at the conclusion of the convention. Please note that continuing nursing education credit and NAB approved administrator credit will be awarded for participation at either INT-1 OR INT-1(r), not both.

The Patient-Drive Payment Model (PDPM) is now final with implementation scheduled for October 2019. Register for convention and receive the answers to your implementation questions during a 4-hour intensive session - Replacing RUGs – CMS’ New SNF Payment System & How to Get Ready for October 2019 Implementation. The intensive will be held on Sunday, October 7.

AHCA’s educational approach to PDPM will be to offer a holistic picture of how PDPM impacts SNFs and will incorporate PDPM interactions with:
• Requirements of Participation,
• Survey and Licensure,
• SNF Re-Hospitalization Measure Value-Based Purchasing,
• IMPACT Act Quality Reporting Program, and
• Other payers’ (Medicare Advantage and Medicaid) and their probable responses to PDPM.

In addition to in-depth training on the PDPM final rule, a member’s only tool kit will be introduced that will contain the core competencies framework and a readiness review tool that will help you track your operational readiness for PDPM. The intensive will also cover data gathered from 12 companies testing impacts of PDPM and provide hospital and discharge pattern data that could be helpful in member markets. Finally, a panel discussion of AHCA members will discuss opportunities and potential pitfalls for SNFs as they consider operational changes necessary to be successful under PDPM.

(This an encore of the Sunday, October 7 session)

Learning Objectives:

Mike Cheek

Senior Vice President, Reimbursement & Legal Affairs

Email Address:

Telephone Number: (202) 454-1294


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Daniel E. Ciolek, PT, MS, PMP

Associate Vice President, Therapy Advocacy
American Health Care Association

Email Address:

Telephone Number: (202) 898-3174


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Robin L. Hillier, CPA, STNA, LNHA, RAC-MT

Director Reimbursement and Quality Metrics
Welcome Nursing Home

Robin L. Hillier, CPA, STNA, LNHA, RAC-MT is the co-owner of Lake Pointe Rehabilitation and Nursing Center in Conneaut, Ohio abd Quality Life Services - a home healthy agency in Ohio. She is also President and owner of RLH Consulting, which has provided operational, quality, and reimbursement consulting to long term care providers since 1998. She is a certified public accountant, a state tested nurse aide, a licensed nursing home administrator, and Resident Assessment Coordinator-Certified and a Master Trainer through the American Association of Nurse Assessment Coordinators. She is a member of the AANAC Expert Advisory Panel.

Ms. Hillier has almost 30 years' experience in long term care, including facility operations, quality improvement, MDS, case mix, cost reporting, rate setting review and analysis and reimbursement consulting and representation for skilled nursing facilities and ID/DD providers.

Ms. Hillier is the Independent Owner Representative on the American Health Care Association Board of Governors and serves on the Executive, Business Management, Audit, Finance, ID/DD, and Public Education and Communication Committees. She is a Past President of the Ohio Health Care Association's Board of Directors and served on the board for 16 years. She also previously held the offices of President, Vice Chair, Secretary and Treasurer, and is a past chair the OHCA Payment for Services Committee and the Convention Task Force. She is Past President of the Educational Foundation of the Ohio Health Care Association (EFOHCA) and serves on its' Education Committee. EFOHCA provides scholarships for long term care employees who are advancing their education and provides continuing education to long term care professionals.

Spouse Name: Steve

Email Address:

Telephone Number: (330) 807-2850

Provider Type: Nursing Facility

Provider Status: For Profit

States Operating In: OH

PAC donor level: Platinum Plus

Providers: Provider


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Anne Tumlinson

Anne Tumlinson Innovations, LLC

Anne Tumlinson is the founder of Anne Tumlinson Innovations and Daughterhood with 25 years of research and consulting experience in post-acute and long-term care financing and delivery. Anne’s work helps organizations respond successfully to payment and delivery reform, and develops innovative ideas and strategies for public policy change – especially important as we prepare the country for demographic shifts.

Anne has testified before the House Energy and Commerce Committee and Senate Aging Committee, and appeared before the Congressional Long-Term Care Commission, and the Bipartisan Policy Center. Her testimony has consistently emphasized that the under-financing of long-term care is an economic problem for families and caregivers, and stifles innovation needed to help them. In support of this work, Anne researches, writes and speaks about innovation in aging services, contributing to Health Affairs and McKnight’s Long Term Care News.

Anne has also created a consumer website,, to generate and improve information for caregivers navigating the health and elder care systems. Daughterhood is a nationwide community of caregivers who educate and inform others.

Anne served previously as a Senior Vice President at Avalere Health, where she founded and led Avalere’s post-acute and long-term care consulting practice for 14 years. She created, developed and launched a data-based provider navigation tool for post-acute care placement and led many analytic and modeling projects for a wide variety of clients. Prior to that, she led Medicaid program oversight at the federal Office of Management and Budget.


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Nate Ovenden, RAC-CT

Senior Medicare & Managed Care Consultant
Good Samaritan Society

Email Address:

Telephone Number: (605) 323-3007


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Deb Bielek, MS CCC SLP

Therapy Resource Education and Programs
Ensign Services, Inc.

Email Address:

Telephone Number: (949) 616-4573


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Francine Rainer, MA, CCC-SLP

Chief Clinical Officer

Fran Rainer is the Chief Clinical Officer for PruittHealth. She has served in the Post-Acute Care industry for 20 years. Fran graduated from N.C. State University in 1995 with a BA in Communication Disorders. Fran received her MA in Speech Language Pathology and Audiology from S.C. State University in 1999. Fran is currently pursuing an MBA/ MHA from Georgia State University.
Fran began her career as a speech-language pathologist, where she enjoyed enhancing the lives of our most vulnerable citizens. Fran spent more than 10 years as a clinician while managing teams of therapists. In 2008 Fran joined PruittHealth as the Post-Acute Care Coordinator. In that role, she worked to develop clinical and rehabilitation programs to support PruittHealth’s expanding model of care. Fran supported and coordinated training for more than 80 skilled nursing facilities across the southeast in comprehensive programming for aquatic therapy, balance re-training, respiratory programs, pain management, infusion therapy, cardiac rehabilitation, and restorative nursing programs.
In 2011 Fran matriculated into clinical reimbursement. As the SVP of Reimbursement Fran and her team of reimbursement consultant support and train skilled nursing facilities related to the RAI process including reimbursement and regulatory requirements. She developed an onboarding/ training manual for the MDS coordinator that lead to improvement in retention in that role. Fran served as the project lead for a successful transition from ICD-9 to ICD-10. In the role of SVP of Reimbursement, Fran assists PruittHealth to be positioned to be prepared for CMS initiatives such as the requirements of participation (ROP), value-based purchasing (VBP) and the SNF Quality Reporting Program (QRP).


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INT-1 (r) - Replacing RUGs – CMS’ New SNF Payment System & How to Get Ready

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