Patient Legal Advocates

Information for clients/patients needing legal assistance around lost benefits or insurance.

The movement of many insured into “managed” environments has resulted in some questions to the HCA of MA regarding clients’ rights should home care services be terminated or suspended. Every Managed Care Organization (MCO) or Accountable Care Organization (ACO) – be they serving Medicare or Medicaid clients – has an obligation to have some form of patient (although not necessarily agency) internal appeal process. Agencies who are working with these organization should be versed in what these processes are.

For clients for whom the changes are threatening their well being, or seemingly discriminatory, or based on a pattern of inappropriate clinical decision making, there are legal services entities in this state who may be able to help. This list includes their names and contact information. Please note: these legal services entities will generally only take up a case if a client or, in some cases, a family member of a client calls. Keep this information on hand and share with any client who may need assistance.

Return to www.thinkhomecare.org.

HCA of MA Has Got You Covered for PDGM Education

HCA of MA is providing 4 unique opportunities at free or discounted rates to learn comprehensive elements of the new Medicare Patient-Driven Groupings Model (PDGM) being introduced this January.

HCA of MA is providing 4 unique opportunities at free or discounted rates to learn comprehensive elements of the new Medicare Patient-Driven Groupings Model (PDGM) being introduced this January.

PDGM: 4-Part Preparedness Series: August 6, 7, 13, & 14
Online Webinar Series

Is your agency prepared for the all the changes that will come with PDGM? This 4-part webinar series with Melinda Gaboury will give you the essentials your agency will need to prepare for PDGM. This series will cover coding changes, OASIS integrity, financial structure changes,LUPA’s, changes revenue cycles, and more!
• August 6th – PDGM Structure and Financial Changes
• August 7th – PDGM Coding & OASIS Integrity
• August 13th – PDGM Operational Decision Necessities
• August 14th – PDGM Revenue Cycle Changes
Instructor: Melinda Gabourey, Healthcare Provider Solutions

REGISTRATION
HCA Members: $379/Line for Full Series
HCA Potential Members: $599/Line for Full Series

All webinars are recorded

2020 Home Health Final Rule: September 11
Online Webinar

The 2020 Home Health Proposed Rule will be a seismic change in home health care. Learn from experts in the industry to help
understand the propsed rule and its impacts. Topics will include a review of Medicare’s new payment rates for home health, changes in use of PT assistants, and informed feedback to provide to CMS by the comments deadline of September 9, 2019, and more!

REGISTRATION
HCA Members: FREE
HCA Potential Members: $99/Line

PDGM Bootcamp: September 24, 9:00-4:00
Methuen, MA

Home Health Care Clinical Managers/Supervisors of Clinical Services, Quality Management staff and Clinical Educators will play a key role in the successful implementation of the new Medicare Patient Driven Groupings payment Model (PDGM). In this interactive session, attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities. Managers will leave with specific techniques for obtaining accurate information to support coding, scoring and billing. All, while using the least resources to produce the best outcomes. Areas covered include: optimizing complex care, episode utilization and case management, interdisciplinary teamwork, care coordination and collaboration. The session will also describe key PDGM measures and monitoring techniques to optimize efficiency, achieve success and prevent pitfalls.

REGISTRATION
HCA Members: $159/Person
HCA Potential Members: $399/Person

PDGM Education by the National Association for Home Care
Online Webinar Series/ Videos

In a partnership with the National Association for Home Care, we are pleased to extend a special NAHC discount on several PDGM educational offerings all members of HCA of MA!

PDGM Video
If you’re familiar with PDGM but aren’t sure what the first steps are, this 5 ½ hour introductory course is for you. Leading industry experts will equip you with what you need to know to about the most significant change to impact home health in decades.

Webinar Series
If you want a deeper understanding of PDGM and how certain components will affect your business, this seven-part series is what you’ve been looking for. These webinars will focus on all parts of your agency, including risk factors, documentation review, clinical management and more. If you can’t attend the live webinar, don’t worry each of them will be recorded and available on- demand. You and your staff will have unlimited access.

Learn more on all education and register at:
www.thinkhomecare.org/Education

Members Flock to HCA’s Quality Improvement Meeting

Lots of member interest in HCA’s July QI meeting to discuss medical record audits and upcoming proposed rule changes.

With the sundry of regulation changes in the home health industry over the past few months, the July 24th Quality Improvement (QI) meeting had over 45 members participating in-person and by phone. The numerous medical record audits plaguing the industry dominated the meeting’s discussion.

Multiple agencies have received letters from C2C Innovation Solutions informing them that some claims under appeal have been selected for potential reopening as part of the Medicare Appeals Demonstration. The C2C auditors are conducting the analysis of claims previously adjudicated unfavorably by the Qualified Independent Contractor (QIC), that are currently pending at the Office of Medicare Hearings and Appeals (OMHA) and may be resolved favorably by the QIC.

Other audits that agencies are experiencing are new Targeted Probe and Educate (TPE) audits. These medical record requests are for 5-7 visits and lengths of stay greater than 90 days. No agency is in the third round of the Face-to Face TPE.

One agency reported at the meeting that they are facing three audits simultaneously; a hospice General Inpatient care (GIP) Targeted Probe from NGS, a home health PERM request for Face-to-Face (awaiting ALJ) and eight GIP Post Payment Review by Noridian.

During the meeting there was a lot of member engagement related the 2020 Proposed Rule; the proposal to require OASIS for all payors and the 8% behavioral adjustment. Agencies also discussed strategies for management with PDGM and the process for completing OASIS B-1 for January 1st episodes. PDGM will be a standing QI agenda item.

The HCA is planning to host a PDGM Networking Meeting to help our members with the transition to this new payment model. We are hoping to begin the meetings in September and have a guest speakers and consultants to assist with planning for this historic payment change. Stay tune for further details.

Don’t forget to check out our PDGM Bootcamp on September 24th!

New PDGM Bootcamp Announced!

HCA of MA has introduced a new full day training on PDGM for Clinical Managers/Supervisors and Quality Management Staff.
https://www.thinkhomecare.org/resource/resmgr/event_forms/PDGM_Bootcamp_Flyer_and_Reg.pdf

Home Health Care Clinical Managers/Supervisors of Clinical Services, Quality Management staff and Clinical Educators will play a key role in the successful implementation of the new Medicare Patient Driven Groupings payment Model (PDGM). In this interactive session, attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities. Managers will leave with specific techniques for obtaining accurate information
to support coding, scoring and billing. All, while using the least resources to produce the best outcomes.

Areas covered include: optimizing complex care, episode utilization and case management, interdisciplinary teamwork, care coordination and collaboration. The session will also describe key PDGM measures and
monitoring techniques to optimize efficiency, achieve success and prevent pitfalls.

PROGRAM OBJECTIVES (At the completion of this session, participants will be able to….)

  • Describe key elements of Medicare’s PDGM payment model
  • Explain the impact of the new regulations on clinical operations and clinical managers
  • Identify key clinical operations changes that will be required for PDGM success
  • Create an initial action plan for successful PDGM implementation

ABOUT THE SPEAKER: Barbara Katz, RN, MSN is an experienced clinician, manager, trainer and health care consultant. Barbara has been a hospital registered nurse, an APRN in internal medicine, a site manager for a Kellogg Foundation self-care education grant, a training manager and a manager of clinical operations for a network of medical practices. She has been Vice President for Clinical Program Development in a large home health care agency where she founded a family caregiver support network.
Barbara provides training in leadership for value based payment, patient self-management support, family caregiver support, process improvement tools and techniques, population health strategies, the use of data
in daily work, communication, teamwork and motivational interviewing.

REGISTRATION:
Members: $159/Person
Non-Members: $399/Person

Or Download the Registration Form Here

“To get others to be involved: This conference was an eye opener to areas we need to improve upon and the tools provided will help in the process. This really brings it all together and a better understanding of PDGM.”

“This was excellent very informative. Made PDGM clear & understandable. Great tips to get started & to stay on task. Barb is a great presenter & her use of handouts was helpful.”

HCA Offers Monthly Aide Webinars to Help with 12-Hour Education Credits

The Home Care Alliance of MA partners with the Association for Home & Hospice Care of North Carolina to put on monthly Aide education webinars. These webinars help satisfy the mandatory 12-hours of education your staff needs to remain complaint.

Take a look below for the following opportunities available until next June! All webinars are just $95/Line for HCA of MA members!

August 8, 2019
TOPIC: The Aide’s Role in Nutrition and Hydration
Speaker: Cindy Morgan, RN, MSN, CHC, CHPN

Description: Nutrition and hydration are necessary to sustain life. The provision of food and water is frequently related to the providing of comfort and nourishment as well as to the giving of life and preserving of life. Adequate nutrition has many advantages to the human body. This presentation will explore some of those, such as: healing, prevention and good health. We will also discuss the element of safety related to nutrition and hydration with a focus on the patient with advanced illness and those at end of life.

September 12, 2019
TOPIC: The Aide’s Role in Advance Directives & Patient Rights
Speaker: Jane Garrett, RN, BSN, MHSA

Description: Legal and ethical responsibilities of the healthcare staff regarding Advance Directives are described from the patient and caregiver’s perspectives. The types of various Advance Directives are explained along with examples and the practical application of this fundamental patient right.

October 10, 2019
TOPIC: The Aide’s Role in HIPAA and Confidentiality
Speaker: Michelle White, DNP, RN, CNL

Description: This workshop will focus on assisting your In-Home Aides in understanding HIPAA and confidentiality guidelines. This workshop will offer practical tips to ensure that the para-professional adheres to the required privacy standards. Also included: the impact of social media such as Facebook, My Space, YouTube and cell phones, text messages, etc.

November 14, 2019
TOPIC: The Aide’s Role in Alzheimer’s and Dementia
Speaker: Kathie Smith, RN, BSN

Description: Alzheimer’s disease (AD) is a type of dementia that affects thought, memory and language.  As the disease gets worse, people often need more and more care. This can be hard for caregivers and can affect their physical and mental health, family life, job and finances. In home aides play a vital role in helping to care for these patients and provide important respite to family caregivers. This teleconference will assist the in-home aide in being able to describe the role they play in helping to manage patients with AD.

December 12, 2019
TOPIC: The Aide’s Role in Maintaining Client Dignity
Speaker: Cindy Morgan, RN, MSN, CHC, CHPN

Description: It is the responsibility of every health care staff member to maintain the dignity of their patients with every contact they have with them. The Nurse Aide works with most patients in an intimate way with the duties assigned to them. This presentation will list strategies to ensure the patient’s dignity is protected.

January 9, 2020
TOPIC: The Aide’s Role in Falls Prevention
Speaker: Jane Garrett, RN, BSN, MHSA

Description:  In this session, there will be a discussion of the many challenges aides face daily in protecting their patients from injury, particularly those resulting from accidental falls. Additionally, as the number of patients with Alzheimer’s Disease and other forms of dementia continues to grow, we all have the added challenge of managing the manifestations of dementia that may increase the risk of falls.

February 13, 2020
TOPIC: TBD
Speakers: John Conrad and Libby Hart, RN

March 12, 2020
TOPIC: The Aide’s Role in Infection Prevention and Control
Speaker: Michelle White, DNP, RN, CNL

Description: This workshop will focus on understanding the basic principles of infection prevention and control. This workshop will also focus on Blood Borne Pathogens and the principles surrounding transmission and methods in which the aide can protect themselves and the patient.

April 9, 2020
TOPIC: The Aide’s Role in Home Care Safety
Speaker: Kathie Smith, RN, BSN

Description: Safety hazards can exist in many areas of the client’s home and the hazards may increase the risk of client falls and other injuries. This workshop will cover ways the In-Home aide can help the client to make their home safer and avoid injury to the client and worker.

May 14, 2020
TOPIC: The Aide’s Role in Understanding the Role of Animals in Patient Care
Speaker: Cindy Morgan, RN, MSN, CHC, CHPN

Description: Do you find that many of your patients have animals as pets and do you wonder why? This presentation will explain the importance of animals to patients. The animal may provide a level of love and care for patients that they get from no other source. There may be times that having to deal with animals in the home are challenging and we will discuss strategies to consider making your visits as pleasing as possible despite those challenges.

June 11, 2020
TOPIC: The Aide’s Role in Recognizing Violence and Patient Abuse
Speaker: Jane Garrett, RN, BSN, MHSA

Description: Many cases of abuse in elderly patients are not reported because they often must decide whether to tell someone they are being hurt or continue being abused by someone they depend upon or care for deeply. This webinar will provide information on recognizing signs of patient abuse and violence and the importance of reporting appropriately.

Check out our calendar at https://www.thinkhomecare.org/page/education for the most up to date information on these webinars and all other education being offered!

New Emergency Prep 4-Part Webinar Series

Agencies continue to struggle with the development of a disaster preparedness plan that will not only be in compliance, but realistic in an event. Areas of weaknesses in the process have been identified by CMS and accrediting bodies. On top of that, there were changes made to regulations at the end of 2018 and appeared in the 2019 interpretive guidelines. This series of one-hour webinars will provide in-depth knowledge of the requirements that home health and hospice organizations are subject to, with specific focus on: an overview of the regulations, starting the agency-specific plan, building the plan, development of policies and procedures, communication, and testing and training.

Program Goals: Through attendance in this web series, participants will increase their understanding of the newly updated federal emergency preparedness requirements that are part of the home health and hospice
Conditions of Participation (CoPs) and become knowledgeable in how to apply the federal requirements for disaster preparedness in their own specific agencies. Enhance disaster plan development for all community based agencies.

Following is the planned content and schedule for the live webinar sessions; for those who are unable to attend the live sessions, recorded sessions will be available.
Please note there is limited seating in the live sessions so please register early.

Part 1: OVERVIEW OF THE REGULATIONS – June 4, 2019, 1:00-2:00 pm EDT
Including Lessons Learned, Home Health and Hospice’s Role in an Event, All-Hazards Approach, Regulatory changes since 2018 and survey findings from the first year under the disaster preparedness CoPs.
Part 2: STARTING AND BUILDING THE PLAN, – June 11, 2019, 1:00-2:00pm EDT
Including Four Phases of Emergency Management, Incident Command System, and Hazard Vulnerability Assessment , Infection control and prevention, Continuity of Operations (Defining Essential Function, Succession Planning, Human Resources, Alternate Location, Defining Patient Populations, and Data Management)
Part 3: DEVELOPMENT OF POLICIES AND PROCEDURES – June 18, 2019, 1:00-2:00 pm EDT
Patient Classification Systems, Transportation Classifications, Surge Capacity, HIPAA/IT, Tracking Patients and Staff, and Roles and Definitions., Organizing the plan.
Part 4: COMMUNICATION/TESTING AND TRAINING – June 25, 2019, 1:00-2:00 pm EDT
Health Care Coalitions; Specific Hospice Requirements; MOUs; Government Emergency Telecommunications System; Collaborative Relationships with Local, State, Federal, and Indian Tribe Nations; Annual/Orientation Requirements, Documentation of Training, Types of Exercises (Tabletop, Functional, Full-scale), After Action Report, Revising and Updating the Plan

REGISTER AT:
https://www.rbclimited.com/product/edp-4-part-series/

DISCOUNT CODE: RBCEDP

Good for all community-based, home care, hospice & Medicare certified home health agencies

Lunch & Learn Series Continues with Discussion on Connecting Care for Patients

There’s a reason for the saying: “It’s lonely at the top.” Being a leader can sometimes become a very isolating experience. With this new “Lunch and Learn” series, HCA of MA is encouraging our industry leaders to ease that executive isolation by joining with a peer group whose responsibilities and challenges mirror your own. Each session features an “expert” talk on a topic of relevance to you as an industry leader. There will also be lunch and plenty of time to talk. Step away from the office, and the phone for a few hours to connect because sometimes “what you know is who you know.”

Connecting Care for Patients: Interdisciplinary Care Transitions and Collaboration
Friday, June 14th, 12:00-2:00PM

Spotty communication, task‐oriented case management, inadequate teamwork and work silos all conspire to fuel poor outcomes, higher costs and staff and patient dissatisfaction. The recently published book Connecting Care for Patients: Interdisciplinary Care Transitions and Collaboration is a powerful system of evidence‐based strategies for reducing fragmentation and achieving quadruple‐aim goals. Come out to hear a high level look at techniques for implementing truly connected care.

Speaker: Barbara Katz, RN, MSN, President, BK Health Care Consulting, LLC

Additional upcoming sessions include:

Gas Explosions in Lawrence MA: Emergency Preparedness, Management and Lessons Learned
Wednesday, July 17

In September, 2018, a series of gas explosions rocked the towns surrounding Home Health Foundation’s corporate office. Thousands of residents, including HHF staff, patients and families were impacted, and HHF was plunged into rapid implementation of their emergency plan. What followed was a testament to the importance of preplanning and how a creative, nimble and dedicated team can make all the difference in the face of an unprecedented emergency. As the fires receded and life began to return to normal, the emergency team moved into after-action analysis in order to continously improve the quality and scope of its emergency preparedness. This presentation will describe in detail the pre-, inter-, and post-emergency activities employed, and lessons learned.

Speakers: Donna Beaudin, OTR/L, MBA, CHC, NHA, Corporate Compliance Officer, Karen Gomes, RN, MS, CPHQ, President and CEO

Medicare Advantage’s New Supplemental Benefit: Plan Views And Next Steps
Monday, August 26

As part of the Chronic Care Act of 2018, Medicare Advantage (MA) plans were allowed greater flexibility in structuring and targeting supplemental benefits, so that plans could offer benefits to “maintain the health or function of chronically ill enrollees” that are not “primarily health-related.” A small percentage of plans added some services in 2019 (primarily nicotine replace therapy) In the only report of its kind, the Long term Quality Alliance interviewed Medicare plans to identify challenges that they face in including a supplemental benefit in their MA bid and preparing to launch it. Hear about LTQA’s findings as well as their recommendations for statutory, regulatory or CMS Guidance they are looking toward to move this important change forward.

Speaker: G. Lawrence Atkins, Executive Director, Long-Term Quality Alliance in Washington, DC.

Registration is just $40/Person!