The Official Publication of the Home Care Association of ... · health care, hospice, or private duty home care: 1. Universal coverage – There are a number of sections of Title

Home CareThe Florida

ConnectionThe Official Publication of the Home Care Association of Florida

Fall 2010

PRSRT STD U.S. Postage

PAIDPembina, NDPermit No. 14

FogNavigating Through the

of Health Care Reform

The Home Care Association of Florida 5

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The Florida Home Care Connection is published for The Home Care Association of Florida 1331 East Lafayette Street, Suite C Tallahassee, Florida 32301 Phone: (850) 222-8967 Fax: (850) [email protected]

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©2010 Matrix Group Publishing Inc. All rights reserved. Contents may not be reproduced by any means, in whole or in part, without the prior written permission of the publisher. The opinions expressed in this publication are not necessarily those of Matrix Group Publishing Inc. Printed in Canada.

ContentsFall 2010

9 12

Up Front7 A Message from the HCAF

President

Cover Story9 Navigating Through the Fog


Features12 Medical Homes – New Models

For Patient Care

14 Complying With Medical Director

Requirements Will Help HHAs Avoid

Sanctions and Overpayments

16 A Therapist’s Perspective on Home Care

Changes

Report from the Legislature18 Home Care’s Regulatory Environment Creates More

Challenges for Your Business

About HCAF20 Upcoming Events 2010

21 Get the Most Out of Your HCAF Membership!

22 Buyers Guide

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As someone who hAs worked in the home care industry for 26 years now, I’ve seen many changes in our industry, but never as many challenges as we face today. These challenges cover a variety of issues that affect our ability to provide adequate access to quality patient care and make a reasonable profit. Some of these changes threaten the survival of home care agencies—maybe even yours. We are operating in an ever-increasing regulatory environment at both the state and federal levels that re-

quire more administrative resources, more documentation, more skilled nursing and therapy resources and lower reimbursements. It is a classic “do more with less” scenario and it’s getting worse.

On the regulatory front, even private duty requirements proposed by AHCA are looking more and more like those in place for Medicare and

Medicaid-certified agencies. While other industries prepare for health care reform, home care has been hit with a disproportionate share of cuts to reimbursements under Medicare—8.25 percent in the last two years and more to come in January 2011. The Medicaid reimbursement in Florida for skilled home care services hasn’t seen an increase in more than 21 years—it ranks 49 out of 50 states.

It’s time to become proactive in standing up for home care and the patients and clients we serve. Other health care industries have fared better than home care in the rollout of health care reform at least in part because they have been more successful in exerting political influence and political fundraising. Many of these other providers also stand to significantly increase the number of patients served since there are tens of millions of Americans who were previously uninsured and who now will be seeking treatment with new medical coverage. There will be a large pent-up patient demand to address medical issues that previously have been ignored because of a lack of insurance and financial resources to seek medical help. That is not the case for home care, since our patient base has been predominantly influenced by age and eligibility for Medicare.

We need your help to raise the voice of home care providers in Florida to our current legislators and those who are running for office. At the HCAF Annual Conference in June, our Board of Directors approved a Grassroots Advocacy Plan that expands HCAF’s visibility and strives to educate both legislators and the public on the importance of home care services for patients, clients and their families. The Faces of Home Care Public Awareness Initiative will be expanded to feature more home care

up frontA Message from the HCAF President

Teresa Corbin

“It’s time to become proactive in standing up for home care and

the patients and clients we serve. Other health care industries have

fared better than home care in the rollout of health care reform at

least in part because they have been more successful in exerting

political influence and political fundraising.”

hCAF Board of DirectorsPresident: Teresa CorbinVice President: Terri SantangeloSecretary: Glenda A. BurkeTreasurer: Anthony ClarizioDistrict I Director: Linda HammontreeDistrict II Director: Kathleen Burcham District III Director: Lisa Caamano District IV Director: Deborah BarkerDistrict V Director: Denise BellvilleDistrict VI Director: Maggie LazarreDistrict VII Director: Sharon WilliamsDistrict VIII Director: John RyanDistrict IX Director: Bob QuinnDistrict X Director: Clarice ContiDistrict XI Director: Jose FoxPrivate Funded Director: Kim ChampionAssociate Member Director: Melinda Gaboury

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patients and their compelling stories of how home care has positively affected their lives. The Grassroots Plan also expands categories of membership in our Political Action Committee (PAC) to include corporations, to encourage contributions by all members to the PAC and expand the association’s influence in the political arena. The HCAF PAC is one of the most visible and effective means of advocacy on behalf of home care providers in Florida.

How can you participate? Frankly, we need your contribution to the HCAF Political Action Committee. You can participate with a contribution as small as $25 or as large as $5,000. Individuals and corporations can both contribute. The PAC funds are used to provide financial contributions to those who are running for political office and who support issues affecting the home care industry in non-federal elections here in Florida.

The need has never been more urgent, nor the stakes as high as they are today. The home care industry’s survival and patients’ access to care are both at risk. In the absence of adequate access to needed home care services, patients will seek emergent care, and overnight stays in hospitals and other skilled facilities will skyrocket, not unlike they did in the late 1990s. The result will be much higher expenditures for medical care, creating an even larger financial burden on a struggling health care system.

Take action today! It takes just a few moments to write a check and support the home care industry in our efforts to protect home care agencies and the patients and clients we serve.

I appreciate your support. Together, we can make a difference!

Please make all checks payable to “HCAF PAC” and mail your generous contribution to:

1331 E. Lafayette St., Suite C Tallahassee, FL 32301 HC

Teresa Corbin is The PresidenT of The board of direCTors of The home Care assoCiaTion of florida and Can be reaChed aT [email protected].


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Fogt was a spectacular Sunday after-noon in October as we sailed past the Marblehead lighthouse on the great north coast of the United States. We were on Lake Erie, sailing from South Bass Island and the little vil-lage of Put-in-Bay back to Bay Point Yacht Harbor in Marble

Head, Ohio. As we sailed past the

lighthouse, we noticed a huge fog bank approaching us from behind and before we reached the entrance to the harbor, we were totally engulfed in fog. We could see nothing but light gray mist and hear nothing but the lap of waves against the hull of the boat.

Have you ever been lost in the fog? What happens to you? I’ve been lost in the fog like this twice in my life. The same thing happens each time; my pulse increases, my senses are height-ened and I begin to feel a sense of panic. I want to go faster even though I can’t see where I’m going. I stop trusting the instruments—in this case the compass,

the depth finder, and the navigation chart.

It seems that there are some leaders in home health care and hospice who are feeling that same sense of being lost in the fog with the advent of health care reform. On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. Some provisions took effect almost immedi-ately but most provisions will be imple-mented over the next three years, with many sections taking effect in 2014.

Lost in the fogRight now, many of us are lost in the

fog. This new law is huge and complex. It is divided into 10 Titles, and there are 462 individual sections of the law. In order to fully comprehend what’s in the law, you also need to take into account the Health Care and Education Reconciliation Act of 2010 that was signed into law by the President on March 30, 2010, as well as provisions of the Social Security Act, the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code.

After reading many sections of the law and spending much time read-ing interpretations of those sections that affect home care & hospice, I’m convinced that there is probably no one individual who has read and fully understands every facet of every provi-sion of this complex legislation.

So what is a home care or hospice executive to do when you are lost in the fog of complexity?

Breaking it down into manageable pieces

To help our readers and workshop participants navigate through the fog of health care reform, we’ve studied the law and its implications. We’re in the process of preparing an industry sur-vey to find out what leaders are most concerned about. We’ve broken the law down into some manageable pieces.

There are five major elements that will affect you as a leader in home health care, hospice, or private duty home care:1. Universal coverage – There are a

number of sections of Title I of the

The hottest topic on the minds of home care and hospice owners and administrators right now is health care reform, and how this new law will affect their businesses. Stephen Tweed, CEO of Leading Home Care, offers some clarity on the Patient Protection and Affordable Care Act.

By Stephen Tweed, CSP


Navigating Through

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Patient Protection and Affordable Care Act that require individuals to purchase health care insurance, that require employers to make insurance available and that change the rules for health insurers. The concept is that if everyone has health insurance, it will be less expensive to provide health care for everyone.

2. Reimbursement There are a number of provisions that change reimbursement under Medicare and

Medicaid for hospitals, physicians, skilled nursing facilities, home health and hospice. Much of the cost of health care reform will be paid out of proposed savings to Medicare, so reimbursement will go down for most providers of care.

3. Regulation There are dozens of provisions in the law that say, “…the Secretary of HHS must …” Each of these required regulations will create a new bureaucracy to write and enforced regulations.

4. Innovation The law creates the Center for Medicare and Medicaid Innovation, and established numer-ous demonstrations projects to test new methods of delivery, new methods of reimbursement and new approaches to care for the elderly and disabled. There is a whole new focus on chronic disease and on wellness and prevention.

5. Economic impact There are numerous new economic provisions including new taxes, new annual fees and changes to the current tax code. It is pretty clear that these new taxes and fees will have an economic impact on home care and hospice by increasing the cost of what we buy, from health insurance to pre-scription drugs to medical devices. There’s even a new tax on indoor tanning salons.

Lighting the wayAs the captain of your home care or

hospice ship, you need to light the way through the fog for the other members of your leadership team and for all of your agency employees, patients and referral sources. They need to feel the confidence that you understand this situation and that you have the confidence to lead them forward even when the future course is uncertain. Here are five things you can do to navigate your agency through the fog of health care reform:1. Anchor your agency on solid

ground Make sure that your organi-zation is built on a solid foundation of mission, vision and values. Make sure that you are focused on taking care of patients, taking care of your employ-ees and being a solid citizen in your community and running a financially strong business.

2. Watch the weather forecasts While no one really knows what will happen with health care reform because it is both a legal issue and a political issue, there will be clues coming out on a regular basis. As the captain of your ship, you need to be paying attention to the factors that will affect the imple-mentation of this new law. While the TV weather man isn’t always right, he does give us some indications of what’s coming.


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Read. Attend conferences, webi-nars and tele-seminars. Be involved in your state and national home care association. Gather as much information as you can about the implementation of the law and have this be a regular topic of discussion in your senior management meetings.

3. Focus your beacon Like a light house, you can penetrate the fog by focusing. In this case, it means focus-ing on your core business of home care and hospice and making sure that you continue to build on your clinical expertise and operational efficiency. The agencies that do the best with these new changes will be those that get high quality outcomes for patients and referral sources in a very efficient manner.

4. Shine your light brightly The other factor in assuring survival and success is to build your market share. That means shining your light and letting your patients, families and referral sources know what makes your agency different. Those agencies that survive and prosper will be those that have significant market share and are in demand by patients and referral sources.

There will always be a demand for home health care, hospice and private duty home care. However, there may not be a need for as many different companies as we have today. There may be some fall out as the econom-ics change and as regulations make the business more complex. Those agencies that are the strongest finan-cially and competitively will be the long term winners.

Develop a focused business strat-egy and sales and marketing plans to bring in more referrals that turn into admissions. Having relationships with referral sources that know and trust you will bring a steady stream of new patients during the times of change and challenge.

5. Be a port in the storm When you have done the first four steps effec-tively, you will be in a position to help others weather the storm of health care reform. Many folks will be battered by the changes. If you are strong and if you can offer support and encourage-ment, you’ll be a valuable resource in your community. However, if your agency is battered by the changes, you’ll be struggling for your own sur-vival and will not be a resource for your patients, employees and referral sources.

Overcoming fear of the unknownWe all have some level of fear of the

unknown. With a huge, complex body of unknowns like these health care reform laws, it’s natural to have some fear. My wife, Elizabeth Jeffries, RN, is a professional speaker, author and execu-tive coach. She describes “courage” as feeling the fear and moving forward anyway. As leaders in home care and hospice organizations, we need to have courage, accept some level of fear of the unknown, stay focused and move forward. Gather information, stay informed, edu-cate your leadership team and develop strategies to strengthen your agency.

Home care and hospice is a resilient industry. We’ve been through economic and regulatory storms before and we’ll get through this one. It just means paying attention, developing clear strategies, and taking action. HC

Stephen tweed haS Spent the paSt 25 yearS working with home care and hoSpice organizationS. he iS ceo of Leading home care baSed in LouiS-viLLe, ky. tweed iS the editor of home heaLth care today and the pubLiSher of private duty today. he can be reached at www.Leadinghomecare.com or by caLLing (502) 339-0653.

Stephen wiLL be providing a fuLL-day

workShop for hcaf on december 10th

in orLando titLed, “academy for private

duty”, See www.homecarefLa.org/caLendar for detaiLS.

© 2010 Stephen c. tweed. SpeciaL one time permiSSion to reproduce granted to the home care aSSociation fLorida.

“While no one really knows

what will happen with health

care reform because it is

both a legal issue and a

political issue, there will be

clues coming out on a regular

basis. As the captain of your

ship, you need to be paying

attention to the factors that

will affect the implementation

of this new law.”

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medical home, also known as a patient-centered med-ical home (PCMH), is a

multifaceted source of personal primary health care. It is based

on a relationship between the patient and physician, formed to improve the patient’s health across a continuum of referrals and services. Primary care organizations have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans. The term “medical home” was first coined by the American Academy of Pediatrics in 1967.

In the medical home, responsibility for care and care coordination resides with the patient’s personal medical provider working with a health care team. Teams

New Models for Patient Care

By Lisa Remington, Publisher, The Remington Report; President, The Alliance For Integrated Value-Driven Healthcare

The relationship between patient and physician is extremely important in providing optimal health care. Patient-centered medical homes are fulfilling this need for an ongoing relationship between patient and physician and one-on-one comprehensive care.

Medical Homes

form and reform according to patient needs and include specialists, mid-level providers, nurses, social workers, care managers, dietitians, pharmacists, physi-cal and occupational therapists, family and community. Care is coordinated across all elements of the health care system (e.g., between primary and specialty care phy-sicians and between hospitals, nursing homes, home health agencies, etc).

Key characteristics of a PCmh:Personal physician:• Each patient has an ongoing relationship with a personal physician who has been trained to provide first-contact care response, as well as continuous and comprehensive care;Physician-directed medical prac-•tice: The personal physician leads a team of professionals at the practice level who collectively take responsibil-ity for the ongoing care of patients;Whole-person orientation:• The personal physician is responsible for providing for the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life, including acute care, chronic care, preventive services and end-of-life care; andCare is coordinated and/or inte-•grated: Across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, and nursing homes)

and the patient’s community (e.g. family, public and private community-based services), care is facilitated by registries, information technology, health information exchange and other means to ensure that patients get the indicated care when and where they need and want it.

examples of medical home models/pilots

All payers are developing medical homes models. Two examples below show the savings medical homes have achieved:

1. The Geisinger Health System: a large integrated delivery system in Pennsylvania implemented a PCMH redesign in 11 of its primary care practices beginning in 2007. Their ProvenHealth Navigator model focuses on Medicare beneficiaries, emphasizing primary care- based care coordination with team models featuring nurse care coordinators, EHR decision support and performance incentives.

Two-year follow-up results from an as-yet unpublished controlled evaluation show:

Better quality: • Statistically significant improvements in quality of preventive services (74 percent improvement), coronary artery disease (22 percent) and diabetes care (34.5 percent) for PCMH pilot practice sites; andReduction in costs: • Statistically significant 14 percent reduction in total hospital admissions relative to controls


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and a trend towards a nine percent reduction in total medical costs at 24 months.

2. The Guided Care PCMH model: developed by an interdisciplinary team at the Johns Hopkins Bloomberg School of Public Health, features care coordination by RN-primary care physician teams work-ing in community-based practices.

Guided Care RNs are trained to coor-dinate care, monitor patients and teach patients and families self-management skills, including early identification of wors-ening symptoms that can be addressed before an emergency department or hospital admission becomes necessary. The RNs focus on Medicare beneficiaries in the top quartile of health risk.

A preliminary evaluation after eight months of a cluster randomized trial of this model involving 904 patients has been published in a peer-reviewed journal. The trends indicate, on average:

24 percent reduction in total hospital •inpatient days;15 percent fewer ER visits;•37 percent decrease in skilled nursing •facility days;Annual net Medicare savings of $75,000 •per Guided Care nurse deployed in a practice; andThe Guided Care patients were more •than twice as likely as usual care patients to rate the quality of their care highly.

Future for medical homesMedicare is developing a medical

home demonstration in which Medicare beneficiaries with multiple chronic condi-tions designate a certified physician to provide them with comprehensive and coordinated care for a per-patient care

management fee, in addition to the usual fee-for-service payments. Other medical home mod els to be tested by the new Cen-ter for Medicare and Medicaid Innovation include patient-centered medical homes for high-need individuals, medical homes that address women’s unique health care needs and models that transition primary care practices away from fee-for-service–based reimbursement and toward compre hensive or salary-based payment.

The reform law also will establish community-based health care teams to support medical homes in small practic-es; entities eligible to serve this func tion will include states or state-designated entities and Native American tribes or tribal organizations. It will allow states to enroll Medicaid beneficiaries with chronic conditions into a “health home,” in which a team of health professionals provides a comprehensive set of medical services, including care coordination.

Independence At home (IAh): A new chronic care coordination benefit for medicare’s most frail elders

The Independence at Home became law on March 23, 2010, as part of the Patient Protection and Affordable Care Act, Pub. L. 111-148. The provision requires the Secretary of HHS to make a new chronic care coordination benefit available to 10,000 Medicare beneficiaries suffering from multiple high-cost chronic diseases in a three-year demonstration project. The IAH provision states that the program must begin no later than January 1, 2012. However, it could be implemented this year because CMS is to receive $5 million in 2010 and each year thereafter through 2015 to cover the cost of implementation.

The Independence at home program:

Provides a new chronic care coordination •benefit for frail Medicare beneficiaries who have difficulty getting to and from a physician’s office; Allows beneficiaries to maximize their •independence by bringing primary care to them in their homes furnished by physician-nurse practitioner-direct-ed teams of health care professionals tailored to their chronic conditions;Mandates reduced health care costs by •at least five percent; andCan be implemented immediately.•For additional details, go to: www.aahcp.

org.

Patient Centered Medical Homes are emerging as a leading model for efficient management and delivery of quality care. Home care has an opportunity to become an important part of patient centered medical homes as care coordinators, case manag-ers, geriatric care management, developing specialized programs and providing hospice and palliative care programs. HC

lisa remingTon is PresidenT of The allianCe for inTegraTed value-driven healThCare and Publisher of The remingTon rePorT. wiTh over 20 years of healTh Care exPer-Tise, remingTon has beCome naTionally known for a 100 PerCenT aCCuraCy raTe for foreCasTing healThCare’s emerging Trends. This unique knowledge base allows her To Provide inTegraTed, value-driven soluTions aCross The healThCare delivery sysTem from hosPiTal To PosT-aCuTe serviCes. www.remingTonrePorT.Com

2010 CoPyrighT The remingTon rePorT for The home Care assoCiaTion of florida

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eeping up with the ever-changing home health anti-remuneration laws in Florida has been no easy task for home health

agencies (HHAs). Prior to 2008, Florida law did not impose strict licensure requirements upon

home health agencies that engaged physicians as medical directors. Since 2008, however,

the rules of the road have changed no less than three times. These frequent changes have left many home health

agencies wondering what the require-ments are for a legitimate medical director arrangement; how many medical directors can they hire; and what types of patients, if any, can the HHAs’ paid medical director refer to the HHA?

what is required of medical director agreements?Florida law expressly provides that each licensed HHA may

hire one medical director, Fla. Stat. 400.474(6)(h). In order to comply with Florida law, there must be (1) a written medical director agreement that is signed by both parties; (2) the contract must provide for remuneration that is at fair market value for an hourly rate, which must be supported by invoices submitted by the medical director describing the work performed, the dates on which that work was performed, and the duration of that work; and (3) the contract must be for a term of at least one year. Further, the hourly rate specified in the contract may not be increased during the term of the contract. In the event the paid medical director refers Medicare patients to the HHA, then the arrangement also must comply with the federal Stark Law.

Of course, the medical directors’ services that the physician furnishes must be legitimate services that the HHA needs for purposes of its operations. Any HHA that pays physicians for services the HHA does not need could face licensure sanctions as well as potential overpayment liability.

how many medical directors may a hhA hire?Florida law clearly limits each licensed HHA to only one paid

“medical director.” Some have argued that because the Stark Law and the Federal Anti-kickback Statute do not prohibit HHAs from hiring more than one physician to be a medical director, then Florida law on this point must be preempted. Others have argued that preemption does not apply in this context. Although these arguments are interesting, no court has ruled that Florida’s “one-paid medical director” law is preempted by federal law. Absent such a ruling, any HHA that pays multiple referring physicians to serve as the HHA’s medical directors proceeds at its own risk.

Are there limits on the number or types of patients a hhA’s paid medical director can refer to that hhA?

Assuming the HHA’s medical director arrangement is documented properly with a written medical director that complies with the requirements referenced herein, the HHA’s medical director can refer as many patients as he or she desires to the HHA. However, if the HHA participates in Medicaid, the medical director is not permitted to refer any Medicaid patients to the HHA (unless a rare exception applies under Fla. Stat. 409.905(4)(c)). HC

Craig smiTh is a ParTner wiTh hogan lovells llP and Chief legal advisor To The home Care assoCiaTion of florida and Can be reaChed aT [email protected].

By Craig Smith, Partner with Hogan Lovells LLP and Chief Legal Advisor to HCAF

Complying With Medical Director Requirements Will Help HHAs

Avoid SanctionsOverpaymentsand


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he role of therapy in the Medicare Home Health benefit has grown steadily through subsequent

refinements of the PPS model. As CMS gained insight into how clinical care goals are efficiently achieved, the importance of safe mobility and ADL function became clear. The patients that demonstrate safe performance levels in

these areas are the patients that stay safely in their home and ultimately require less medical services. Recognizing this fact, the initial PPS model featured

significant cost factors directly based on therapy volumes. Though the 2008 New Rule altered how therapy visit totals related to the final HHRG score, the role of rehab remained prominent in the reimbursement formula.

Recently, Home Health has seen significant activity in the area of claim audits and denials of care that are intended to protect the integrity of Medicare expenditures. While these audits seek to analyze programs with the intent of eliminating fraud and abuse, their approach also identifies un-covered or in-efficient care practices that commonly exist in most care delivery. The lack of an effective audit mechanism to date has often lead clinicians (the author included) to self-interpret both CMS regulations and expectations. Since most of the audits focus on the financial content of the claim, the focus of the audits is primarily, and expectedly, on therapy care delivery.

Additionally, the 2011 Proposed PPS Rule, recently released for public comment, goes further in defining changes to therapy requirements and coverage that will challenge even the most veteran clinician. New plan of care and visit documentation requirements, re-evaluation rules and decreases in the types of declines that are covered, will combine with the audit changes to create shorter, more focused therapy programs in the future.

Agencies whose therapy programs are built on certification period based durations (60 days) will most likely encounter

care denials; those patient programs that extend into multiple certifications will receive higher levels of scrutiny. Eventually, the provider must address the financial realities of the denied programming and the therapists will have to find ways to re-package their clinical care into coverable forms. When considering these facts, many questions come to mind; what are the first steps to take in modifying our care, what will therapy in home care look like in the future, and what’s the best for the patient, and the industry?

The initial approach to re-packaging therapy care into programs that meet coverage requirements is to internalize that there may be more progressive methods available than the traditional means so many of us use. Outcome statistics, compiled by Medicare since the introduction of PPS, demonstrate that functional improvements do not increase with longer duration therapy programs; in fact, they decrease in extended therapy episodes. CMS audits reveal that both Home Programs and compliance are not optional, so address and obtain both on the first visit. By establishing home programs and progressing them each visit, compliance is reinforced and the pace of progress is quickened. Therapists will need to consciously be transparent and deliberate in both of these areas to obtain the desired re-wiring of their care approach.

Next, patient and caregiver education are required to compliment the compliance with the ever-changing home program. Routine therapy visits should always include the performance and skilled progression of the functional deficit-based home program, capturing potential progress and building on the compliance occurring between visits. This will allow the therapist to focus on the ongoing documentation of functional gains as a result of the skilled interventions and relate the progress on a per visit basis to the objective tests and findings from the initial evaluation and plan of care. Absolute inclusion and implementation of these important steps will be required to validate programs, episodes and claims in the future. Herein lies the key to clinical success for therapists

A Therapist’s Perspective on

Home Care ChangesA look at how Home Health therapy will change in the near future, and why treating patients for multiple episodes of care isn’t best for the patient, or the industry.

By Arnie Cisneros, P.T., President of Home Health Strategic Management and Home Care Clinician


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continuing to deliver care under these new requirements: It is not about less visits; its about best practice care delivery with required elements that help achieve a greater percentage of clinical goals faster than currently expected. Post-discharge home programs serve an important role by helping patients complete un-covered gains independently after the therapy visits cease.

Home Health must address the dual problem of decreased funding for an expanding, baby boomer laden population. By utilizing statistics culled from Start of Care and Discharge OASIS documents since the onset of PPS, CMS has determined that the progressive approach they are mandating (education, compliance, assertive programming with patient/caregiver buy-in) maximizes the value of the benefit, thereby allowing the expanding target population to receive home care services for years to come. So, when we look at the therapy programs of the future, they are shorter in duration, clinically efficient and achieve goals at a higher rate due to full patient compliance and education, focused care delivery and post-discharge expectations. This clinical model will serve patients by assuring contemporary care delivery; will serve the benefit by assuring program integrity and value-based care, and will serve clinicians by allowing them to continue on the care path of the future. HC

arnie Cisneros will kindly be Providing a webinar for hCaf TiTled, “2011 PPs rule: PrePare your agenCy and CliniCians for survival”, on november 9, 2010, 1:30 P.m. - 3:00 P.m. (esT). hCaf is Pleased To have sPonsorshiP suPPorT from healTh Care synergy for This webinar. Please see www.homeCarefla.org/Calendar for deTails.

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employee background screening

With the passage of HB 7069 during the recent Florida legislative session, the requirements for background screenings were raised for those who work with children, the sick and the elderly. The Level 2 Screening requirement became

effective August 1, 2010, and includes a fingerprint check through the FDLE and FBI databases, with a mandate for electronic fingerprints. The roll-out to the marketplace has been challenging for providers, since many of the AHCA-endorsed background screening vendor’s sites were not operational on the effective date. As a result, AHCA has allowed vendors to continue to accept hard fingerprint cards for a limited time to allow candidates to be screened in areas where the availability of LiveScan vendors is limited or non-existent.

What are the new requirements? As of August 1, 2010, all new hire employees and contractors alike are required to undergo Level 2 Screening and the screening requests will be processed directly by the vendors providing the screening service. Contractor screening results may be retained by either the employer or the licensee where the contractor provides contract services. The vendors approved by the FDLE will then report the results to AHCA. Previously, AHCA had processed the screening requests and the fees. AHCA estimates the turnaround time for reporting of the results to be five to seven business days, and the results will now be available on the AHCA Background Screening Results Website

only—providers will no longer receive written notification of screening results.

If a criminal record search yields incomplete information, AHCA will only contact the person screened, due to the confidential nature of the screening process, using certified mail delivery. As a provider, if you experience a delay in obtaining screening results, AHCA encourages you to contact the individual directly.

If you are responsible for reviewing screening results and haven’t yet set up an AHCA account to view them, you can email: [email protected] to request an AHCA access number. Please include the name of your company and your contact information including name, phone number and email address for follow-up.

Recently, AHCA announced that Level 2 screening results from several other state agencies may also be deemed proof of compliance. They must have been completed within the last five years, final determination must be provided, and the person must not have been unemployed for more than 90 days (note: type of employment is not specified). These agencies include the Department of Health, the Department of Children and Families, the Agency

Home Care’s Regulatory Environment Creates More Challenges for Your Business

legislative update

By Lisa S. Stanley, Governmental Affairs Director


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for Persons with Disabilities and the Department of Financial Services.

It’s important to note that all employees, including those employed prior to August 1, 2010, must attest to meeting the new requirements as found in FS 435.05(2), and agree to inform the employer immediately if arrested for any disqualifying offenses. This form replaces the Affidavit of Good Moral Character, and a signed copy must be maintained in the employee’s personnel file.

You can find a copy of this Affidavit of Compliance with Background Screening Requirements Form and the latest information on background screening on the HCAF website at www.homecarefla.org. Visit the Background Screening Update section on the Public Policy & Advocacy page.

HACF has worked diligently with AHCA during the initial implementation period to keep them apprised of the challenges providers have faced in attempting to comply with this new background screening requirement. As a result, we have received written assurance from Liz Dudek at AHCA that providers who make a good faith effort to comply with the new provisions will not be sanctioned, provided they document their efforts to comply.

Cms 2011 reimbursements for medicare patients

While the state legislature and AHCA were addressing background screening, at the federal level CMS has been busy reviewing upcoming payment schedules that will significantly affect your Medicare reimbursements. As you may know, CMS implemented three rate reductions to address case mix weight changes in 2008, 2009 and 2010 for a total reduction of 8.25 percent. An additional reduction of

2.71 percent was planned for 2011. Under the proposed rule

changes that would update the Home Health Prospective Payment

System (HH PPS) reimbursement schedule, the reduction for 2011 would be a whopping 3.79 percent in 2011 and an additional 3.79 percent in 2012.

Senators Collins (R-ME) and Feingold (D-WI) have co-sponsored the Home Health Care Access Protection Act that would establish a reliable and transparent process for determining

whether the proposed payment cuts are warranted. CMS views the proposed cuts as needed to account for improper changes in case-mix scoring. This Act would also require the Secretary to justify any future cuts. At press time, neither Senators LeMieux (R-FL) nor Nelson (D-FL) had signed on to support this legislation. HC

for quesTions regarding This arTiCle, Please ConTaCT kyle simon aT [email protected].

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OCTOBER 2010 October 26 9 a.m. – 5 p.m. Tampa, Florida ICD-9 Coding, Intermediate Level

October 26 9 a.m. – 11 a.m. Tampa, Florida Districts V and VI Meeting

October 26 12 p.m. – 1 p.m. Home Health Evidence Based Practice Webinar

October 27 9 a.m. – 5 p.m. Orlando, Florida ICD-9 Coding, Beginning Level

October 28 9 a.m. – 5 p.m. Orlando, Florida ICD-9 Coding, Intermediate Level

October 29 9 a.m. – 11 a.m. Orlando, Florida District VII Meeting

October 29 9 a.m. – 5 p.m. Orlando, Florida ICD-9 Coding, Intermediate Looking to Advance Level

NOVEMBER 2010 November 1 8 a.m. – 4 p.m. Naples, Florida ICD-9 Coding, Beginning Level

November 2 8 a.m. – 4 p.m. Naples, Florida ICD-9 Coding, Intermediate Level

November 3 8 a.m. – 4 p.m. Miami, Florida ICD-9 Coding, Beginning Level

November 4 9 a.m. – 11 a.m. Stuart, Florida District IX Meeting

November 4 8 a.m. – 4 p.m. Miami, Florida ICD-9 Coding, Intermediate Level

November 5 8 a.m. – 4 p.m. Miami, Florida ICD-9 Coding, Advanced Level

November 9 1:30 p.m. – 3:00 p.m. 2011 PPS Rule: Prepare your Agency and Clinicians for Survival Webinar

November 17–18 8 a.m. – 4 p.m. Orlando, Florida Blueprint for OASIS-C Data Accuracy

November 18 1 p.m. – 2:30 p.m. Care Transitions: Legal Issues Audio Conference

November 18 3 p.m. – 4 p.m. The Home Health Aide’s Role in Preventing Falls Telecourse

November 19 8:15 a.m. – 11:30 a.m. Orlando, Florida OASIS-C Certification Exam

DECEMBER 2010 December 9 3 p.m. – 4 p.m. Telecourse The Home Health Aide’s Role in Depression and Social Isolation

December 10 8:30 a.m. – 4 p.m. Orlando, Florida Academy for Private Duty Home Care

UpcomingEvents

about HCAF

Find more events and register online at www.homecarefla.org/calendar


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Career Center Searching for a job within the home

care industry? Looking to fill a position at your home care agency? HCAF’s Career Center (www.homecarefla.org/jobs) is your destination for exciting home health care job opportunities and the best resource for qualified candidates within the industry. Post job listings, job fairs and your open house opportunities. Your company’s listing will be distributed to more than 2,000 home care professionals and displayed on the HCAF website for 30 days. HCAF members save 20 percent

off all job listing packages! (See advertisement below)

new website In the past two years, HCAF has

undergone major changes—new name, new staff, and now it’s time for a new look! We are in the process of revamping our website in terms of better organization and more content to benefit our members. These changes will include more resources for your agency in every career field, including administration, clinical, human resources, marketing and financial

professionals. While we may have a new look, we remain steadfast in our dedication to serving you! Check out our new look at www.homecarefla.org.

hCAFehighlights This summer HCAF unveiled

HCAFeHighlights, a weekly e-newsletter for members only! This newsletter includes legislative and regulatory news, provider updates, as well as a list of ongoing educational events, and more! Instead of sending our members several emails throughout the week, HCAF has compiled all the

Get the Most Out of Your HCAF Membership!

about HCAF

Continued on next page

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buyers guideCOnSULTInG FIRMS Coleman Consulting Group ........................................................................ 17 Juanda’s Consulting Company ....................................................................3 Solutions For Care Inc. .............................................................................. 15 Synergy Consulting ................................................................................... 17

COnSULTInG FIRM AnD EDUCATIOn Healthcare Consultlink .............................................................................. 19

EMPLOyEE TRAInInG Silverchair Learning Systems ..............................................inside front cover

HOME CARE ACCREDITATIOn, COnSULTInG AnD EDUCATIOn Alternatives – A Consulting & Education Service .........................................8

HOME CARE COnSULTAnTS 21st Century Health Care Consultants .............................. outside back cover

HOME HEALTH SERvICES Gold Coast Home Health Services ...............................................................6

InSURAnCE Uni-ter Underwriting Management Company Ponce de Leon ..................... 15

SOFTwARE Allegheny Software Publishers Inc. .................................... inside back cover Alora Healthcare Systems ......................................................................... 10 HomeTrak ...................................................................................................6 Sandata Technologies .................................................................................4 Spark Technologies (X3) .................................................................11, 13, 15 Stratis Business Solutions ......................................................................... 17

RECRUITInG Exact Recruiting Solutions Inc. .................................................................. 18

REvEnUE CyCLE MAnAGEMEnT Select Data .................................................................................................8

information that is relevant to you into one medium! If you are a member of HCAF and do not currently receive HCAFeHighlights, please call (850) 222-8967.

2010 Advertising & sponsorship Guide

How do you keep current on the many changes in home health care that constantly challenge the home health care industry? How can your company get maximum exposure for its products while showing your support for the industry?

HCAF’s advertising and sponsorship program is designed to help your company seek ways to reinforce your position as a market leader. There are currently several opportunities to get your company’s brand front and center in the industry, including: advertising either on the HCAF website, in our weekly e-newsletter sent to over 2,000 home care professionals or in our tri-annual magazine that is sent to every home care agency in the state of Florida. Additionally, there are many opportunities to sponsor our ongoing educational seminars or other events. To help you learn more about these many opportunities available to your company, visit www.homecarefla.org and check out our Guide to Advertising & Sponsorship (see the link at the bottom of the home page).

2011 Annual Conference and Trade show

Join fellow Florida home care industry professionals to attend education seminars, network with colleagues and visit exhibit booths featuring the latest home health products and services!

June 20-23, 2011walt Disney world Dolphin Resort1500 Epcot Resorts BoulevardOrlando, FloridaMore details: www.homecarefla.org/conference HC

about HCAF

To advertise in The Florida Home Care Connection, please contact Matrix Group Publishing Inc. There are numerous options available to fit all budgets!

Advertise Here!

Tel: (866) 999-1299Email: [email protected]

Documents

The Official Publication of the Home Care Association of ... · health care, hospice, or private duty home care: 1. Universal coverage – There are a number of sections of Title