I began my career in long term care in 1986 and have worked in this profession exclusively. I held various positions in accounting, reimbursement and finance before starting my own businesses. I have worked for national multi-facility organizations, regional accounting and consulting firms, and a small regional multi-facility organization. I have been involved with the design and development of several reimbursement systems in Ohio. I have helped evaluate numerous public policy initiatives related to long term care, provide comments as to the impact, and recommend alternatives that would be more palatable to the profession. I have actively participated in the State budget process – evaluating budget proposals, drafting and providing testimony and developing alternative proposals. I regularly review and comment on CMS proposed rules and rules proposed in Ohio. I am considered to be an expert in MDS and case mix in Ohio and nationally. I served on the Ohio Department of Jobs and Family Services Case Mix Advisory Committee from inception in 1991 through its demise in 2008 due to State budget cuts. This committee was a joint committee of various state department personnel and providers who implemented and oversaw the case mix reimbursement system utilizing RUG III, which became effective in Ohio in 1993. I provide MDS and case mix education through OHCA, AAPACN and various associations and independent or multi facility providers throughout Ohio and nationally. I was actively involved in the development of PDPM and I am currently Co-Chair of the AHCA Reimbursement Cabinet. I serve on the AAPACN Board of Directors and currently chair the NAC Expert Advisory Panel.