Member Profile Survey Question Title * 1. Contact Information Name Title Organization Email Phone Number Question Title * 2. Does your organization have a Home Health Aide Training Program? Yes No If no, where/how do you train your home health aides? Question Title * 3. Does your organization have a Personal Care Aide Training Program Yes No If no, where/how do you train your personal care aides? Question Title * 4. Does your organization have a nurse preceptor program? Yes No If yes, is your nurse preceptor a full-time position? Question Title * 5. Does your organization have a nurse residency program? No Yes Question Title * 6. Does your organization currently host nursing students for clinical rotations? No Yes. Please identify the nursing school. Question Title * 7. Is your organization unionized in the following staff categories? Yes No Aides (Home Health Aides and/or Personal Care Aides) Aides (Home Health Aides and/or Personal Care Aides) Yes Aides (Home Health Aides and/or Personal Care Aides) No If yes, what union? Nurses and/or other professional staff Nurses and/or other professional staff Yes Nurses and/or other professional staff No If yes, what union? Question Title * 8. What Electronic Health Record does your organization currently use? Question Title * 9. Does your organization have a designated contact for the following? Please include name, title, and email or write N/A. Advocacy Emergency Preparedness Billing Media/PR Education Trainer Question Title * 10. Does your organization have an outside Lobby Firm? No Yes. Please identify. Question Title * 11. Does your organization offer Telehealth services? Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. NYS Medicaid covered services provided via telehealth include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a NYS Medicaid member. This definition includes audio-only services when audio-visual is unavailable, or a member chooses audio-only. No Yes Question Title * 12. Does your organization provide any of the following specialty programs? Please select all that apply. Telehealth Wound Care Program Home Infusion Falls Prevention Dementia/ Memory Care Specialized Chronic Disease Management Sepsis Prevention Asthma Intervention Caregiver Program Maternal or Infant Community Paramedicine Care Transitions Primary Care Program Behavioral Health Hospice and Palliative Care Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Programs None Other. Please specify. Question Title * 13. Please identify your organizations primary patient population. Select all that apply. Low-income individuals and families Youth and young adults Young children, pregnant women, and new moms Veterans Persons with special needs Older adults Immigrants Formerly incarcerated individuals Other. Please specify. Question Title * 14. CHHAs, LHCSAs and FI members, from Schedule 19 of your most recently submitted Medicaid Cost Report (2022 reporting year) please provide the following: Total Operating Revenue Total Operating Expenses Question Title * 15. MLTC and PACE plan members, from Schedule B of your 4th Quarter 2023 Medicaid Managed Care Operating Report (MMCOR) please provide the following: Total Operating Revenue Toal Operating Expenses Question Title * 16. Hospice members, from your 2022 Hospice Cost & Utilization Report to DOH, please provide the following: Total Revenue Received (HSR1 #19) Total Program Expenditures (HSR1 #20F) Done
