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384 Results

  • How do I use LTC Trend Tracker as a Skilled Nursing Facility?

    Contains 9 Component(s)

    Learn how to use LTC Trend Tracker as one of your tools for Quality Improvement. In these videos, you will learn how to utilize and modify the skilled nursing dashboard, provide an overview of several key LTC Trend Tracker features & reports, and uploading skilled nursing data.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    image


    Learn how to use LTC Trend Tracker as one of your tools for Quality Improvement. In these videos, you will learn how to utilize and modify the skilled nursing dashboard, provide an overview of several key LTC Trend Tracker features & reports, and uploading skilled nursing data. 

    Learning Objectives:

    1. Learn how to utilize and customize the skilled nursing dashboard
    2. Select benchmark groups to best demonstrate your facility’s strengths
    3. Understand the measures and upload data

    Speaker:

    Lonnita Myles, MBA, Manager, Quality & LTC Trend Tracker, AHCA

  • Assisted Living Action Plan Response for Adverse Events

    Contains 5 Component(s)

    It is critical to address and mitigate adverse events and potential adverse events. An action plan, otherwise known as a mitigation plan, is a necessary response to adverse events and potential adverse events. For many such events, it is important to respond and start the mitigation process immediately. These tools were initially developed by members of AHCA’s Survey/Regulatory Committee and adapted for assisted living communities to assist providers in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Communities may use different titles or terms than the action plans, such as Director of Health Services instead of Director of Nursing, or service plan instead of care plan. Please adapt the plans to reflect your AL community. Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    It is critical to address and mitigate adverse events and potential adverse events. An action plan, otherwise known as a mitigation plan, is a necessary response to adverse events and potential adverse events. For many such events, it is important to respond and start the mitigation process immediately.

    Examples of adverse events/potential adverse events include:

    • Falls (not following the care plan, use of gait belt, one vs. two-person transfers)
    •  Falls with a mechanical lift
    •  Elopement
    •  Allegation of abuse or neglect
    •  Water too hot
    •  Smoking (supervised vs. unsupervised, with oxygen, defined smoking area, all about safety)
    •  Bedrails (entrapment, assessment for use)
    •  Significant medication errors such as cardiac medications, chemo, insulin, morphine, Coumadin
    •  Infection Control – outbreaks (e.g. scabies, bedbugs, MRSA, C-Difficile, Noro Virus, Legionella)
    •  Lack of timely or complete evaluation of a change in condition
    •  Pressure ulcer – lack of prevention or following prevention measures
    •  Grievances and resident/tenant council feedback

    Objectives:

    1. Identify adverse events that could potentially have a negative impact on residents/tenants as well as on a community’s regulatory compliance.   
    2.  Establish a routine root cause analysis process to identify the specific/source, root cause or causal factor of the problem.  
    3.  Create a structured process for developing a mitigation plan to address the adverse event/potential adverse event and minimize similar events for all residents/tenants:
      1. Complete the Initial Mitigation Action Plan 
      2. QAPI members complete the formal documentation of the Mitigation Action Plan
    4.  Use information learned by sharing results and Plan with the QAPI committee for continued monitoring.

    Note: These tools were initially developed by members of AHCA’s Survey/Regulatory Committee and adapted for assisted living communities to assist providers in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Communities may use different titles or terms than the action plans, such as Director of Health Services instead of Director of Nursing, or service plan instead of care plan. Please adapt the plans to reflect your AL community. 

    Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools. 

  • General Resources to Support Implementation and Compliance

    Contains 5 Product(s)

    Phase 3 of the RoPs goes into effect on November 28, 2019. AHCA has developed resources to help you navigate the new requirements. This package includes resources applicable to General Resources to Support Implementation and Compliance.

    Phase 3 of the RoPs goes into effect on November 28, 2019. AHCA has developed resources to help you navigate the new requirements. This package includes resources applicable to General Resources to Support Implementation and Compliance. Such as: 

    • Mitigation Action Plan for Adverse Events (Nursing Center and AL)
    • Integrating the Requirements of Participation into Your Community Morning Meeting/Routine Monitoring Practices/Audits/QAPI Process
    • The Requirements of Participation and Baldrige Connection
    • The Requirements of Participation and Baldrige Criteria
  • Quality Initiatives in Medicaid

    Contains 3 Component(s)

    Our quality-focused webinar will discuss quality initiatives in Medicaid. Included will be potential performance measure development in both fee-for-service and managed care environments. This webinar will also include Value-Based Purchasing, and the technical assistance AHCA/NCAL can provide.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    Our quality-focused webinar will discuss quality initiatives in Medicaid. Included will be potential performance measure development in both fee-for-service and managed care environments. This webinar will also include Value-Based Purchasing, and the technical assistance AHCA/NCAL can provide.

    Learning Objectives:

    1. Learn about key Medicaid VBP rate elements
    2. Understand how state affiliates and AHCA have advocated for VBP programs with state Medicaid agencies
    3. Learn about AHCA VBP support
  • Nursing Centers Action Plan Response for Adverse Events

    Contains 5 Component(s)

    It is critical for nursing centers and assisted living communities to address and mitigate adverse events and potential adverse events. An action plan, otherwise known as a mitigation plan, is a necessary response to adverse events and potential adverse events. For many such events, it is important to respond and start the mitigation process immediately. These tools were developed by members of AHCA’s Survey/Regulatory Committee. Use of these tools does not guarantee regulatory compliance; nursing centers should adapt as needed to ensure compliance with current federal and state requirements. They are not intended as legal advice and should not be used or relied upon as legal advice.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    It is critical for nursing centers and assisted living communities to address and mitigate adverse events and potential adverse events. An action plan, otherwise known as a mitigation plan, is a necessary response to adverse events and potential adverse events. For many such events, it is important to respond and start the mitigation process immediately.

    Examples of adverse events/potential adverse events include:

    • Falls (not following the care plan, use of gait belt, one vs. two-person transfers)
    • Falls with a mechanical lift
    • Elopement
    • Allegation of abuse or neglect
    • Water too hot
    • Smoking (supervised vs. unsupervised, with oxygen, defined smoking area, all about safety)
    • Bedrails (entrapment, assessment for use)
    • Significant medication errors such as cardiac medications, chemo, insulin, morphine, Coumadin
    • Served/consumed wrong consistency of food or liquids
    • Infection Control – outbreaks (e.g. scabies, bedbugs, MRSA, C-Difficile, Noro Virus, Legionella)
    • Fluid restriction not managed or monitored by facility, physician parameters not followed
    • Lack of timely or complete assessment of a change in condition
    • Pressure ulcer – lack of prevention or following prevention measures
    • Grievances and resident council feedback

    Objectives:

    1.  Identify adverse events that could potentially have a negative impact on residents as well as on a center’s regulatory compliance.   
    2.  Establish a routine root cause analysis process to identify the specific/source, root cause or causal factor of the problem.  
    3.  Create a structured process for developing a mitigation plan to address the adverse event/potential adverse event and minimize similar events for all residents:
      •  Review the guidance for determination of avoidable versus unavoidable event
      • Complete the Initial Mitigation Action Plan
      • QAPI members complete the formal documentation of the Mitigation Action Plan
    4. Use information learned by sharing results and Plan with the QAPI committee for continued monitoring.

    Note: These tools were developed by members of AHCA’s Survey/Regulatory Committee to assist centers and communities in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools. 

  • Training Program and Staff Competencies

    Contains 4 Component(s)

    Training Program and Staff Competences will include: training requirements §483.95, A Guide to Staff Stability for Leaders, Staff Competencies and the Facility Assessment for Independent Owners, Improving Clinical Outcomes through Competent Gerontological Nurses

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    Training Program and Staff Competences will include: 

    • Training requirements §483.95 
    • A Guide to Staff Stability for Leaders
    • Staff Competencies and the Facility Assessment for Independent Owners
    • Improving Clinical Outcomes through Competent Gerontological Nurses

  • Medicaid Financing

    Contains 1 Component(s)

    The purpose of this webinar is to map out the basics of how Medicaid is financed, including different opportunities states may pursue and state Medicaid matching pressures. It will include information on the Federal Medical Assistance Percentage (FMAP) and state match rates, provider taxes, intergovernmental transfers (IGTs), upper payment limits (UPLs) as well as supplemental payments.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    The purpose of this webinar is to map out the basics of how Medicaid is financed, including different opportunities states may pursue and state Medicaid matching pressures. It will include information on the Federal Medical Assistance Percentage (FMAP) and state match rates, provider taxes, intergovernmental transfers (IGTs), upper payment limits (UPLs) as well as supplemental payments. 

    Learning Objectives:

    1. Understand state matching requirements and related advocacy strategies
    2. Learn about provider tax and IGT best practices
    3. Learn about pending CMS action on supplemental payment policy

    Presented by: 

    Kathy Gifford, JD, Principal at HMA

  • Quality Initiatives

    Contains 1 Component(s) Recorded On: 10/25/2018

    Our quality-focused webinar will discuss quality initiatives in Medicaid. Included will be potential performance measure development in both fee-for-service and managed care environments. This webinar will also include Value-Based Purchasing, and the technical assistance AHCA/NCAL can provide. Learning Objectives: -Learn about key Medicaid VBP rate elements -Understand how state affiliates and AHCA have advocated for VBP programs with state Medicaid agencies -Learn about AHCA VBP support

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    Our quality-focused webinar will discuss quality initiatives in Medicaid. Included will be potential performance measure development in both fee-for-service and managed care environments. This webinar will also include Value-Based Purchasing, and the technical assistance AHCA/NCAL can provide.

    Learning Objectives:
    -Learn about key Medicaid VBP rate elements
    -Understand how state affiliates and AHCA have advocated for VBP programs with state Medicaid agencies
    -Learn about AHCA VBP support

    Speaker:
    Marsida Domi, MPH
    Senior Research Analyst, American Health Care Association


  • Perception vs. Reality: The Quality Award Program for Assisted Living Providers

    Contains 1 Component(s) Recorded On: 10/19/2018

    On this webinar, we will break down the commonly cited barriers preventing assisted living communities from participating in the program and talk about the many free resources available to help assisted living providers succeed. We will also hear from the two 2018 Gold recipient assisted living organizations about their journey, including how they did it and how it benefited their organization. Join us to learn how the Quality Award program can help you succeed!

    The In a competitive and ever-changing market, assisted living providers must identify ways to stay a step ahead and stand out to potential customers and referral sources. The AHCA/NCAL National Quality Award Program provides the external validation necessary to set yourself apart from the competition. Historically, the Quality Award Program has been perceived as being only for skilled nursing centers. However, more assisted living communities than ever before are applying for and receiving the National Quality Award. In 2018, 114 assisted living centers received the Bronze award, 47 centers received the Silver award and two (the first AL communities) received the Gold award. On this webinar, we will break down the commonly cited barriers preventing assisted living communities from participating in the program and talk about the many free resources available to help assisted living providers succeed. We will also hear from the two 2018 Gold recipient assisted living organizations about their journey, including how they did it and how it benefited their organization. Join us to learn how the Quality Award program can help you succeed!

    Learning Objectives:

    1. Participants will be able to describe the perceived barriers for assisted living participation in the program and how to overcome them.  
    2. Participants will be able to summarize the free resources available to help assisted living providers succeed in the program.
    3. Participants will discover how participation in the program would benefit their organization.  

    Speakers:

    • Alana Wolfe, National Director of Performance Excellence, Sunrise Senior Living
    • Nicolette Merino, Avamere Health Services
    • Kimberly Dilg, Executive Director, Sunrise of Gurnee
    • Marcia Jackson, RN Administrator, Maine Veterans Home – Machias     

    Who Should View This Event: 

    Leadership (i.e. administrator, DON, etc.) at assisted living communities that are members of AHCA/NCAL.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

  • How Independent Owners Can Utilize LTC Trend Tracker℠ Data

    Contains 1 Component(s) Recorded On: 10/18/2018

    Learn the potential of LTC Trend Tracker℠ and how it can help Independent Owners harness the untapped power of the data you collect. This session will provide a brief overview of LTC Trend Tracker℠ for 10 or fewer skilled nursing facilities and assisted living communities to understand its quality improvement and organizational performance benefits.

    Learn the potential of LTC Trend Tracker℠ and how it can help Independent Owners harness the untapped power of the data you collect. This session will provide a brief overview of LTC Trend Tracker℠ for 10 or fewer skilled nursing facilities and assisted living communities to understand its quality improvement and organizational performance benefits. You will learn how to complete the following:

    • Use LTC Trend Tracker℠ to support implementation of quality programs

    • AHCA/NCAL Quality Initiative 3.0 & LTC Trend Tracker℠
    • Enhance external negotiations with entities such as hospitals, managed care organizations, and other networks.

    Want to learn more about LTC Trend Tracker℠? Check out our resource center located at www.ltctrendtracker.com for helpful how-to videos and help documents!

    Questions about LTC Trend Tracker℠? Feel free to email the LTC Trend Tracker℠ team at help@ltctrendtracker.com

    Speakers: Kiran Sreenivas, Director, Research

    If you already have an AHCANCAL account, click the_LOG IN_button at the top right corner of the Home page. There, you will see the familiar AHCA log in screen. Apply your user name and password and you will be redirected to ahcancalED.


    If you are new to the site and are creating an account for the first time, please refer to the attached document: "How to create a new account in ahcancalED". 


    Please note: in order to receive access to this exclusive member benefit, you MUST list your AHCA/NCAL member Facility/ Community/ Company NAME on your account. 


    What if you forgot your password? If you forgot:_click the_LOG IN_button

    at the top right corner of the Home page and you will be redirected to the AHCA log

    in screen. Just below the blue SIGN IN box (toward the bottom of the page) you will see

    a message that says: If you need help retrieving your Username or Password Click HERE.

     

    Need Help? Please email educate@ahca.org for support. 

NCAL AHCA