CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

Volume 26, Number 05MAY 2010CAHSAH Bulletin

IN THIS ISSUE

FEATURES:The Latest on the Red Flags

Rule P. 12

Every year California’s home care community encounters major issues that could have drastic impacts on the services provided in the home to seniors, people with disabilities, and others in

need of care. And every year, whether its budget issues, legislation, regulation, or various other needs of the industry, CAHSAH is involved -- advocating, defending, and promoting home care.

2010 has been an especially active year, with the continued California budget crisis, implementation of national health care reform, a proposed complete overhaul of the Medi-Cal program, and the federal administration threatening to repeal the overtime companionship exemption. Details about these and other major issues, along with CAHSAH’s response to them are below.

BUDGE T California’s budget woes have been well publicized over the past couple years as our huge budget deficits have forced major cuts to spending and have also resulted in tax increases. With Health and Human Services accounting for approximately 30 percent of the state’s expenses, and being the largest expense that doesn’t have a constitutional spending requirement (such as education) it was inevitable that many of the proposed cuts were going to come from that area:

Medi-Cal: At the beginning of the year Governor Schwarzenegger proposed the total elimination of Medi-Cal funding for medical supplies and durable medical equipment (DME) if certain federal funds did not come through. This would have been catastrophic and a matter of life and death for many people who are dependent on supplies for conditions such as tracheostomies, colostomies, and wound care. >ISSUES 2010:

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A Discussion on the Budget and Policy Issues Impacting Home Care in California

On May 6th at CAHSAH’s 2010 Annual Conference and Home Care Expo, five people were recognized for their outstanding

achievements during the Awards Luncheon. The awards were presented by Nominating Committee member Michelle Hofhine with Accredited Home Health Services in Woodland Hills.

The Lois C. Lillick Award was presented to Lucy Andrews, CEO, At Your Service Home Care, Santa Rosa. This award honors an individual who has made outstanding contributions to the continuing development of local, state, and national home care associations. Brittnei Salerno with La Jolla Nurses Home Care in La Jolla gave admiring reviews about Lucy’s many contributions to CAHSAH and California home care.

The Home Care Physician of the Year Award was presented to Dr. Robert Quadro with Mercy Home Health/Mercy Hospice in Rancho Cordova. This award honors a physician who excels in providing and utilizing home care, optimizing the role of home

Contributions to Home Care Recognized

Michelle Hofhine, left, Lucy Andrews, and Brittneii Salerno at the Awards Luncheon during the 2010 CAHSAH

Annual Conference in Sacramento.

Conference Wrap-Up

P. 7, 9

Navigating the Wage Orders!

P. 11

“I am humbled and honored to be among the few to receive the Lois Lillick CAHSAH award for

achievement. I share Dr. Lillick’s enthusiastic love of home care. Home care is my passion and my life’s work for the last twenty years, caring for,

advocating for and celebrating each and every persons’ right to live and die at home...

” Lucy Andrews, CEO, At Your Service Home Care

The CAHSAH Bulletin is brought to you by

McKesson Corporation.

Learn more by going towww.mckesson.com

>AWARDS: continued on p.2

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care in the health care system. Kay Kallas with Mercy Home Health/Mercy Hospice in Rancho Cordova spoke about Dr. Quadro and supported Dr. Quadro as the award recipient with tremendous amount of gratitude for his many contributions to our home care industry.

The Lillian O’Brien Home Care Supervisor Award was presented to Medha Bansode-Ram, with Mercy Home Health/Mercy Hospice in Rancho Cordova. This award was established to honor a first-line home care clinical or office supervisor who has made outstanding contributions in motivating staff to achieve excellence in home care service. Karen Salbato with Mercy Home Health/Mercy Hospice in Rancho Cordova provided testimony of Medha’s supervisory skills.

The Aide-to-RN Scholarship was presented to Jeanne Jensen, with At Your Service Home Care in Santa Rosa. The purpose of the CAHSAH Aide-to-RN Scholarship is to provide support to home health aides who would like to

pursue a nursing degree. Criteria for the scholarship include: Acceptance at an accredited School of Nursing; employment by a CAHSAH member; expressed desire to work in home care after obtaining their nursing degree, and financial need. Lucy Andrews with At Your Service Home Care in Santa Rosa spoke about Jeanne’s desire to help others by becoming a registered nurse. She also shared one of Jeanne’s goals which is to assist home care clients with medical appointments, ensuring they understand their care plans and her need of becoming a registered nurse. Jeanne is currently enrolled in the ADN Program at Santa Rosa Junior College in Santa Rosa.

The Home Care Service Award was presented to Maricela Pulido, Elder Care Guides in San Diego. This award was established to honor an individual, directly involved in day-to-day care, who has consistently provided outstanding service to patients in their homes. Norman Hannay with Elder Care Guides in San Diego provided a moving testimony about Maricela’s devotion to her clients. She was commended for going above and beyond what is expected of a care companion.

CAHSAH would like to acknowledge all of the nominators and nominees for their participation in the awards process and congratulate the winners of these awards. It is not too early to be thinking about next year’s awards and which deserving recipients should be nominated for consideration.

AWARDS: continued from p.1

Dr. Robert Quadro, left, and Kay Kallas.

Medha Bansode-Ram, left, and Karen Salbato.

Pictured: Jeanne Jensen

Pictured: Maricela Pulido

3www.cahsah.org

Question: How does a Hospice discontinue a QAPI Performance Improvement Project?

Answer: From our Hospice QAPI Speaker, Barbara Rosenblum, Founder and CEO Strategic Healthcare

Programs: “When it is determined that you have met your stated goal(s) for indicators or for a project - you document your “results”. To choose new measures or to begin a new project you would then gather data on all aspects of organization (patient outcome, finance etc.) to identify what you need to improve. You can do that with a Performance Improvement (PI) “council” or other management team and present your new plan to whomever your PI plan designates (Board of Directors, Quality Council, CEO etc.) If you choose to discontinue a PI project without meeting goals - you would have to explain that in writing.”

Question: Has the Medicare HIM-11 been replaced by a different resource?

Answer: Yes, the HIM-11 has been replaced by the Medicare Benefit Policy Manual Publication

100-02 Chapter 7. It can be found under internet manuals at www.cms.hhs.gov/manuals. HIM-11 is still available, also at the website listed above under paper based manuals and is a good resource for plan of care requirements.

Question: Where can I find information on how to write an injury and illness prevention program?

Answer: The State Department of Industrial Relations website has guidelines for writing an injury and illness

prevention program which can be found here: http://www.dir.ca.gov/dosh/dosh_publications/IIPP.html

Answering your legislative & compliance questions

Ask Mary

CAHSAH Bulletin Published by CAHSAH

Joseph H. Hafkenschiel, President

California Association for Health Services at Home

3780 Rosin Court, Suite 190 Sacramento, CA 95834Telephone: (916) 641-5795 Fax: (916) 641-5881

www.cahsah.org

For advertising and sponsorship information, contact:

Ranesh Maharaj, Bulletin EditorE-mail: rmaharaj@cahsah.org (916) 641-5795 ext. 120

CAHSAH does not necessarily endorse any of the products, services or meetings advertised in the bulletin. CAHSAH also does not endorse

the opinions, products or services of guest authors in the bulletin.

WNU HeadlinesMay 3rd: Labor Dept. Plans to Review Companionship

The Department of Labor (DOL) plans to review regulations regarding the companionship exemption, announced in last week’s Federal Register. According to the Department, “In light of significant changes in the home care industry, the DOL is proposing to update regulations at 29 CFR part 552, application of the FLSA to domestic service, including examining the definition of “companionship services,” the criteria used to judge whether employees qualify as trained personnel who are not exempt companions, and the applicability of the exemption to third party employers.”

May 10th: CMS Notifies Contractors: New Pay Rates on Home Health Rural Add-on

The Centers for Medicare & Medicaid Services (CMS) has advised the Regional Home Health Intermediaries (RHHIs) and New England Medicare Administrative Contractor (MAC) regarding updates to episodic and per-visit rates under the Home Health Prospective Payment System factored in with the new 3 percent rural add-on. The rates apply to home health episodes ending on or after April 1, 2010 and before January 1, 2011.

May 10th: CMS Rescinds Transmittal on ‘36-Month Rule’

The Centers for Medicare & Medicaid Services (CMS) has withdrawn Transmittal 318/Change Request 6750 known as the “36-month rule,” and will limit the rule’s application to full changes in ownership only. The rule states that the Medicare provider agreement and billing privileges of a home health agency will not be transferred to the new owner if the agency is sold within 36 months of its enrollment in the Medicare program.

May 17th: DHCS Releases Waiver Implementation Plan

CAHSAH President Joe Hafkenschiel attended the May 13th meeting of the Stakeholder Advisory Committee for the Section 1115 Medi-Cal Waiver proposal. The Department of Health Care Services (DHCS) released an Implementation Plan which calls for mandatory enrollment of Medi-Cal beneficiaries in managed care plans in 12 counties beginning in February 2011. The most prevalent comments were that the lack of detail in the plan made it more of a concept paper than an implementation plan. Many participants commented that the timeline in the plan was far too ambitious.

May 24th: Supreme Court Requests View on the Medi-Cal 10% Injunction Case

The state of California, in response to the federal court’s rulings that placed an injunction on the 10 percent rate decrease to Medi-Cal reimbursements, filed a petition to the U.S. Supreme Court. After review, the U.S. Supreme Court has requested the U.S. Solicitor General Elena Kagan to file the views of the United States in respect to the injunctions of the 10 percent rate decrease which CAHSAH’s attorneys, the Medicaid Defense Fund, obtained in August and November 2008. Click here for the full article.

4 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

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<<< ISSUES 2010 continued from p.1

In response, CAHSAH helped organize a coalition of Medi-Cal stakeholders who developed an advocacy strategy opposing the cuts resulting in the website www.

savetheoptionals.com. Additionally, CAHSAH asked our members to identify clients who utilize these services, whom we then contacted and brought to Sacramento for a day of meetings with legislators and budget staff in efforts to educate the lawmakers of the critical necessity of these supplies. As a result of these efforts, the Governor proposed in his May Revise to instead put caps on the utilization of these supplies at the 90th percentile, which is an improvement on the administration’s original proposal but still an item that CAHSAH is aggressively opposing.

Another major issue relating to Medi-Cal is the section 1115 waiver renewal. This waiver is scheduled to expire this year and the California Department of Health Care Services (DHCS)is proposing to submit a new waiver to the federal government that would require all seniors and people with disabilities on Medi-Cal to be mandatorily transferred to managed care as opposed to fee-for-service care. By doing so the state believes they will save approximately $130 million per year in Medi-Cal, while claiming to maintain the quality of care of recipients.

Many advocates have strongly opposed the mandatory enrollment to managed care and have expressed tremendous concern over the department’s proposed short timeframe to enroll over 200,000 people into managed care. CAHSAH has attended stakeholder meetings, commented on sections of the proposal, and met with the Chief Deputy Director of Operations at DHCS to discuss the necessary precautions and oversight needed during implementation if the proposal is approved.

Another strategy CAHSAH has utilized in our efforts to improve Medi-Cal Home Health is litigation. During the past two years the state has been sued by various Medi-Cal advocacy groups, including CAHSAH, and the courts have most times ruled in favor of the advocates opposing rate reductions or other types of cuts. CAHSAH is currently involved in two lawsuits: one which has been longstanding for several years seeking to require the state to produce an adequate rate review for past years, as they are required to do by federal law; and another which successfully reversed the 2009 10 percent rate reduction to Medi-Cal providers. CAHSAH is now awaiting a decision regarding retroactive

reimbursement for the last case and is optimistic about the outcome.

Respite: Services for people in the Regional Center system have had significant cuts last year and this year the Governor has proposed a 1.25 percent provider payment reduction, which is in addition to the 3 percent reduction from last year. CAHSAH has been integrally involved with the cut to in-home respite services and attempts to mitigate excessive harm created by last year’s budget that placed a cap on respite hours. As a result of months of advocacy work and lobbying, the Department of Developmental Disabilities agreed to convene a workgroup to specifically address the cut to respite and the legislature has asked for a new proposal to include in this year’s budget.

Companionship Exemption

Over the years several attempts have been made to eliminate the federal companionship exemption through state and federal legislation. All attempts to require overtime pay and minimum wage, however, have failed due to the impact it would have on an individual’s ability to have continuity of care at a manageable cost. Secretary of Labor, Hilda Solis, however, has recently stated that she will propose the elimination of the federal companion exemption through regulation only.

If the exemption were eliminated the cost of home care would either drastically increase, or workers and recipients would no longer have the continuity of care they need. CAHSAH has contacted members of Congress to set up meetings and has also developed a task force to develop and identify strategies to pursue in opposing the regulatory proposal.

>ISSUES 2010: continued on p.5

Secretary of Labor, Hilda Solis, however, has recently stated that she will propose

the elimination of the federal companion exemption through

regulation only.

www.cahsah.org

Legislation

Every year California legislators introduce thousands of bills and CAHSAH analyzes all of them to determine whether or not they could impact home care. Although legislation has definitely taken a back seat to budget discussions the last couple years, there are still bills that are significant to home care, such as:

AB 179: This is CAHSAH’s bill authored by Assemblyman Portantino (D – Pasadena) which would exempt home care companies from the requirement for “temporary services employers” to pay workers every week as opposed to every other week. CAHSAH has met several times with labor representatives and the legislature in efforts to resolve the issue but labor has not yet agreed to a deal.

AB 950: This bill proposes to allow the existence of hospice facilities under the current hospice license. CAHSAH is taking an active support position on this bill and is working with various stakeholders to navigate it through the legislative process.

SB 998: This bill would require the State Department of Health Care Services to initiate a process to develop, by no later than July 1, 2012, a tool for the uniform long-term care services assessment of individuals in order to assist consumers in finding long-term care services of their choice.

Licensing & Cer tif ic ation

Every quarter CAHSAH meets with the Licensing and Certification Division of the California Department of Public Health to get updates on backlogs, licensing fees, and other important issues that have direct impact on

home health and hospice providers. Many of our discussions in 2010 have revolved around outstanding regulations that the department has not implemented and CAHSAH ‘s pressure to get the department to do so. One of the regulations involves CAHSAH sponsored legislation, AB 993, from 2008, which reduced the home health aide training requirements from 120 hours to 75 hours. The department has been challenging the new law and has only recently agreed to the new requirement and has begun working on regulations.

The second major issue is the one-year nursing requirement nurses must have before home health agencies can hire them to work in the home. For the past six years the department has been “working” on regulations to eliminate this one year requirement, until very recently when they announced to CAHSAH that they are no longer willing to eliminate the requirement. CAHSAH will continue to fight against the department’s position so that home health agencies can hire much needed staff to provide life saving services to individuals in their homes.

<<< ISSUES 2010:continued from p.4

Every year California legislators introduce thousands of bills and CAHSAH analyzes all of them to determine whether or not they could

impact home care.

RX STAFFING AND HOME CARE

PRO-CARE HOME HEALTH SERVICES

ACCREDITED MEDICAL SUPPLY

NATIONAL PRIVATE DUTY ASSOCIATION,

SOUTHERN CA CHAPTER

ORANGE COUNTY REGIONAL COUNCIL

COMPETENT CARE HOME HEALTH NURSING

LOS ANGELES REGIONAL COUNCIL

MAXIM HEALTH CARE SERVICES

SAN DIEGO REGIONAL COUNCIL

WILSHIRE HEALTH AND COMMUNITY SERVICE

SOUTHWEST TECHNOLOGIES

ACCURATE BUSINESS RESULTS, LLC

AT YOUR HOME FAMILYCARE

OSO HOME CARE, INC.

CARDIOCOM

JOE HAFKENSCHIEL, CAHSAH

COLONIAL HOME CARE SERVICES, INC.

CTK INSURANCE

Accurate Business Results

Hospice of the East Bay

McCoy & Connolly Consulting

A SPECIAL THANKS TO OUR

2010 PAC SPONSORS & CONTRIBUTORS

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CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

CAHSAH Welcomes New Members!

Please help us extend a warm welcome to those new members who have recently joined CAHSAH between April 20, 2010 and May 17, 2010.

ProvidersAiding Seniors At Home, Inc.,

Anaheim, CA

All For You Home Care Services,

Citrus Heights, CA

BrightStar of San Juan Capistrano,

San Juan Capistrano, CA

CA Reliable Home Health Care,

San Diego, CA

CareAssist Services,

Dana Point, CA

Hanna’s Home Healthcare,

Fremont, CA

Prime Hospice Care LLC,

Simi Valley, CA

The Experienced Home Care Registry, Inc., Vista, CA

Visiting Angels,

Sacramento, CA

AffiliatesAvinash Alimchandani,

Lake Forest, IL

Ayn Bautista,

Oxnard, CA

CHAP - Community Health Accreditation Program,

Washington, D.C.

Peninsula Care, LLC,

Daly City, CA

Skysoft Systems,

Victoria, BC

AnnaLiza Wilensky,

Vallejo, CA

CTK North American Insurance Services, LLC, Anaheim, CA

Nancy Kline,

San Francisco, CA

New Provista Website!!!PROVISTA, a CAHSAH Group Purchasing Program, has a new website. It is much easier to navigate, research, view pricing, access contracts. With over 1400 product contracts, the process can appear overwhelming, but the new website mitigates those problems.

Whether you have already enrolled in the program or are considering enrollment, take the time to view the archived Provista webex. Click here.

2011 Home Care Resource Guide and Directory

It’s time again to compile the 2011 Home Care Resource Guide & Directory. By now you should have received, via email, instructions and your password, allowing online access to review and make any changes to your agency information. Since the hardcopy guide is produced only once a year, be sure to take advantage of this opportunity to provide necessary updates. You have a short window of time in which to do this. We encourage early participation.

S N E A K P R E V I E W

7www.cahsah.org

Seventy-nine vendors participated at this year’s expo, 16 of which were first time exhibitors. What a great show of support for the home care industry! We look to our vendors as problem solvers, providers of solutions and

educators, all of which help agencies to be more competitive and successful. They are a vital component of the association.

Food was in ample supply, as well as ‘liquid refreshment”, with multiple lounges where attendees could take a break from the day’s activities while renewing their energy to complete the tour of the exhibit hall.

And where else does money actually grow on trees?

The conference theme “Money Matters: Investing in the Future” was carried throughout the expo hall with a giant money tree in the center. Piggy banks, dollar bills and gold/silver coins were plentiful.

Raffle prizes were generously donated by our vendors – from flip camcorders to iPods to gift cards. The Grand Prize went to Trudy Miller, Adventist Health Homecare & Hospice Services – Mendocino County – a complimentary one night stay with dinner at Porter’s Steakhouse at the Doubletree, Ontario, and a complimentary conference registration for 2011. CONGRATULATIONS, TRUDY!

Attendees were provided a Sneak Preview of CAHSAH’s new RAMP program which will be launched in the near future, and our valued Home Care Aide Certification Program was given top billing during the exhibit hours. Our new member attendees were welcomed by a volunteer member, as well as welcomed at the Business Luncheon by Brittnei Salerno, Chairperson of the CAHSAH Board of Directors. Fourteen individuals representing eight new member agencies attended the 2010 conference. Welcome!

2010 EXP0: A Wealthy Participation

ALPHA HOSPICE CARE, TorranceBlue Star Home Health, Inc., ChatsworthFamily inHome Caregiving, Inc., MontereyHuddleston Care, LLC, BurlingameINDECARE In-Home Care, SacramentoLove At Home Quality In Home Care, Fair OaksNorth Cal. Home Health Care Inc., San FranciscoRight at Home of Mt. Diablo

CAHSAH offers a special thanks to our Affiliate Advisory Committee for their ideas and guidance in preparation of the 2010 Expo:

Tami Unsworth, Heffernan Insurance Brokers John Shinn, PPS Plus Software Jason Best, Kinnser Software

Diane Brabetz and Michelle Hofhine provided invaluable onsite assistance as well.

And, of course, we extend our appreciation

to the 2010 exhibitors, many of which were also sponsors of various conference events. YOU ARE THE EXPO! THANKS TO ALL!!!!!!

8 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

21st Century Health Care Consultants5 Star Consultants, LLC

Accreditation Commission for Health Care, Inc.X Accredited Medical SuppliesAccurate Business Results, LLC

Advanced Diabetes SupplyAllscripts

American HealthCare Capital American Veterans Care Coordination, LLC

ARKRAY USAAuthentidate Holding Corp.

Barney & Barney, LLC Boyd & Nicholas, Inc. Byram Healthcare

Calmoseptine, Inc.Cardiocom

X Care West Insurance Risk Management CareCentric, Inc.

CareVoyant, Inc.CellTrak Technologies, Inc.

Cerner BeyondNow CHAP, Inc.CHAP, Inc.Coloplast

ComForcare Senior Services Continuity Care Staffing Services, Inc.

ContinuLink Health Technologies, LLCConvatecCovidien

CTK North American Insurance Services, LLC Delta Health Technologies, LLC

Deyta, LLCEnterprise Fleet Management

eSolutions, Inc.Fazzi Associates, Inc.

Gentiva Health ServicesGulf South Medical Supply

Healthcare Provider Solutions, Inc.X HealthCare Synergy, Inc.

HealthMEDX, Inc.HealthWyse, LLC

X Heffernan Insurance Brokers CAHSAH GPO VENDORHomeCare HomebaseHoneywell HomMed

Hospice Partners on CallHospiScript Services, LLC

Intel CorporationKaiser Permanente

X Kinnser Software, Inc.Livermore & Associates, Inc. Mainstay Business SolutionsMaxim Healthcare Services, Inc.

McBee Associates, Inc. McKesson

McKesson Medical Surgical Medline Industries, Inc. MSC Care Management

NDSI Healthcare, Inc.Philips Telehealth Solutions CAHSAH GPO VENDOR

Pinnacle Quality Insight PPS Plus Software

Precision Medical Billing Procura

Provista CAHSAH GPO VENDORX Sandata Technologies, Inc.

Select DataSheridan In Home Care, Inc. Shield Healthcare

Southwest Technologies, Inc. Spark Technologies

Strategic Healthcare Programs, LLC CAHSAH GPO VENDORStratis Business Systems, Inc.Suncoast Solutions

The Braff Group The Corridor Group, Inc. Trusted Hands Network

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Everything You Need to Know about Palliative CareBy Marianne Matzo & Deborah Witt Sherman

Product Description:

Palliative care is a philosophy of care giving that integrates disease modification with supportive, compassionate therapies for patients at the end of life. Palliative care nurses are responsible for alleviating pain and other physical symptoms-along with satisfying the emotional, social, cultural, and spiritual needs of patients who are facing life-threatening illness.

This third edition of Palliative Care Nursing provides more comprehensive newly updated content, knowledge, attitudes, skills, and cutting-edge teaching and learning strategies to achieve the AACN End-of-Life nursing competencies providing a lifespan approach. Now in its third edition, this book continues to emphasize the value of complementary, holistic modalities in promoting health, wholeness, and wellness, even as death approaches.

Key topics discussed:

Ethical aspects of palliative care •Legal aspects of end-of-life decision-making •Loss, suffering, grief, and bereavement on the •part of patients and their families Symptom-specific nursing management of pain, •anxiety, depression, fatigue, malnutrition, and dehydration-all common to palliative care How to communicate with the seriously ill and •dying patients, their families, and their health care providers Disease-specific aspects of palliative care for •those battling cancer, heart disease, lung disease, HIV/AIDS, end-stage renal and liver disease, neurological, and other disorders

MEMBER: $75.00NON-MEMBER: $90.00

CAHSAH BOOKSTORE

*prices include shipping, handling & taxCall (916) 641-5795 ext. 113

or visit www.cahsah.org to order these essential resources!

R aff le Prize Donations X 2010 Conference Sp onsors

9www.cahsah.org

Attendees consisted of clinicians, front line supervisors and managers, and senior administration of which 69 percent have been working in the home care industry for more than 10 years. The diverse representation of auspice consisted of 45 percent private duty and 35 percent Medicare Certified.

The traditional conference welcome reception was sponsored by Sandata Technologies, Inc. The event consisted of endless networking and loads of hors d’oeuvres and a hosted bar. It gave attendees a chance to check-in, get their registration packets, and just relax with colleagues.

The conference featured some of the best known industry leaders in home care and hospice. To kick off the conference, special guest and keynote speaker Val J. Halamandaris, President of the National Association for

Hospice and Home Care (NAHC) sponsored by Kenyon Consulting, gave an update on healthcare reform. From the encouraging outlook of the keynote to the inspiring leadership session, many left these sessions feeling inspired.

From cracking the referral code to orientation strategies, and advocacy in action, the first set of concurrent sessions opened the gate for new members. But it was the remaining courses that hurdles were overcome. Attendees learned how to manage the bumps in the road for successful OASIS-C, achieve cost efficiencies in back office staffing and structure, and how to decrease operating cost while increasing customer satisfaction. Even operations got wind on navigating the wage orders, increasing field staff productivity, understanding and managing four generations in the workplace, turning around turnover, and keeping the heroes and losing the zeros. Although the education sessions were exciting, it was the PAC event that drew the most attention. With food, cocktails and gaming tables, what was there not to love?

As CAHSAH continued to offer a variety of education sessions in six tracks, many expressed that it was difficult to choose just one session in each time slot. The faculty offered a wealth of knowledge and detailed information on each topic. All evident in the evaluations and comments received from attendees:

I t ’ s a W r a p

“As usual the conference was a fantastic bargain for the money spent. Powerful educational sessions with new concepts and

interesting twists on old standards. Thanks, CAHSAH Staff, for putting together another phenomenal seminar!”

“The whole conference provided top dollar in a tough economy.”

“I always learn and grow when I attend a CAHSAH Conference. The speakers stimulate me to think through current

approaches, processes and actions. The added bonus is to see and visit with colleagues and get recharged and motivated and

even affirmed.”

Staff and the CAHSAH Education & Conference Committee put remarkable amounts of time into selecting the best and most-qualified instructors to make your learning experience focused and applicable. If you missed out on the conference, check our website for recorded sessions available as an on-demand course. The 2010 CAHSAH Conference may be over, but it will definitely be long remembered. Thanks to all for making this year’s conference a success!

Mark your calendars now and make plans to attend next year’s conference scheduled for May 10-13, 2011

in Ontario, California.

Company’s

MedicareCertified35%

Home CareAide16%

Home Infusion Pharmacy1%

Affiliate5%

InterdiciplinaryProfessional Services3%

Licensed Home HealthAgency29%

HME2%Hospice

5%Other6%

Primary Auspice

Attendee

Other12%

Job Position

Mid Level Management/Front Line Supervision25%

Clinician/Staff6%

Senior Administration58%

CAHSAH’s Annual Conference The CAHSAH 2010 annual conference was one of the best in content and locations by far. Situated in the Capitol City, the Sacramento Convention Center and Hyatt Regency Hotel were host to the conference, providing an intimate environment

and timely curriculum allowing attendees to maximize their ROI for education dollars.

CAHSAH President Joe Hafkenschiel,

left, and NAHC

President Val Halamandaris,

at the 2010 CAHSAH

Annual Conference in

Sacramento.

10 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

UPDATE How to Get More Referrals for your Home Care or Hospice Agency

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There are so many factors to consider when referral sources place patients in a home care or hospice agency. But one factor that impacts the distinction of one agency from another is the successful management of that agency. Great management leads to great

results, creating a cycle of success in providing quality care to patients - a key decision factor when referrals are made. Make sure your Administrators are well educated in all areas of their responsibility to ensure success. The investment you make today in attending these upcoming certificate programs will long last this slowing economy.

Brought to you by: CAHSAH with the support of The Corridor Group, NAHCAll certificate programs sponsored by: Care West Insurance Risk Management

HOSPICE ADMINISTRATOR CERTIFICATE PROGRAM Sponsored by: HospiScript, LLCJuly 20-22, 2010 – Las Vegas, NV

HOME CARE ADMINISTRATOR CERTIFICATE PROGRAM Sponsored by: NewTech Care/Spark Technologies, and HealthCare Synergy Inc.July 21-23, 2010 – Las Vegas, NV

HOSPICE EXECUTIVE CERTIFICATE PROGRAM Sponsored by: HospiScript, LLCNovember 2-4, 2010 – New York, NY

HOME CARE EXECUTIVE CERTIFICATE PROGRAM November 3-5, 2010 – New York, NY

Save an extra $25 when registering two or more people from the same agency online.For more information or to register, please visit: http://www.cahsah.org/?p=certificate_programs

June 24-25, 2010 - Las Vegas, NV

Starting a home health agency is a unique kind of entrepreneurship with challenges that require solutions specific to home health. Often people will start their own agency before they completely

understand the clinical, regulatory, and business issues they will be facing. The need, and demand, for education is high but many agencies have difficulty finding educational resources specific to their situation. CAHSAH has always been dedicated to helping home health agencies succeed and has developed a basic program to answer common questions and walk new owners through the process of launching a successful agency. Each agency will also receive a complimentary copy of the HHA Start Up Manual, a CAHSAH resource valued at $400.

Expo of “Must Know Vendors”We are also very excited to announce that you will be able to peruse through a small expo that consists of “must get to know” vendors who will be a great resource for you. Here are a few vendors you can expect to see:

Community Health Accreditation Program (CHAP)•Accreditation Commission for Health Care (ACHC)•Kinnser Software •Heffernan Insurance Brokers•Care West Insurance•Healthcare Provider Solutions, Inc.•

For more information or to register, please visit: http://www.cahsah.org/educational_events/10StartUpHHA.asp

Sponsored by: Kinnser Software THE STAKES ARE HIGH: Ensure your New Home Health Agency’s Success!

11www.cahsah.org

Come One, Come All! Academy for Private Duty Home CareCAHSAH and Academy Leader, Stephen Tweed would like to extend a personal invitation to all Private Duty leaders to attend the Academy for Private Duty Home Care. As a result of this intimate, high-impact learning experience, leaders in Private Duty Home Care companies will be able to: Set direction and develop action plans to grow business, find and keep the caregivers you need to grow your business and serve clients, increase personal income and much, much more! All attendees will receive a copy of the Academy for Private Duty’s Home Care Manual. Register now to save your seat! Register two or more people and save $50 per person.

September 23, 2010 – Orange, CAFor more information please visit our website.

The Art of ICD-9 Coding UPGRADECASHAH’s most popular coding class just got an upgrade! The intermediate level of the coding series has completely been revamped to give you a closer look at the specific coding guidelines that are exclusively relevant to home health chapter by chapter from the official source references. Attendee favorite and coding expert Sparkle Sparks has spent countless hours reviewing your questions and revising the format to fit your needs! She will discuss the latest guidance from CMS related to the completion of M1024 and other diagnostic criteria for the completion of OASIS-C. Included in the training will be the completion of coding exercises as well as analysis and comparison of these common home health scenarios to help facilitate the integration of the more complex coding concepts and fulfill your quest for coding accuracy. Coding is a very dynamic skill set, it is critical to know the most current changes in order to maximize your reimbursement and receive an accurate payment. Make sure you don’t miss out as this is the last time this class will be offered this year!

June 7-8, 2010 – Ontario, CABasic & Intermediate Courses offered.

June 10-11, 2010 – Sacramento, CAIntermediate & Advanced courses offered.

For more information, please visit our website.

OASIS-C and Billing Webinars Educate More Staff for Less!

Are you fully aware of the impact to your agency since the new OASIS-C data set was implemented? CAHSAH and Health Care Provider Solutions have teamed up to provide you with the education necessary to

stay in compliance. A series of OASIS-C and Billing Audio/Web Conferences are now available. Save time and money by educating your staff from the comfort of your office. All seminars are taught by billing expert Melinda Gaboury, CEO of Healthcare Provider Solutions, Inc. For more information or to sign up for these courses, please visit our website.

OASIS-C Resistance is Futile! OASIS-C Medical Review Issues Home Health Billing: Tackling Medicare Advantage/HMO Claims Hospice Billing: Basics for Billing Medicare Correctly Home Health and Hospice Billing: Looking ahead to 2011

June 17, 2010:July 29, 2010:

August 19, 2010:

September 23, 2010:

October 14, 2010:

Navigating the Wage Orders:

Paystubs, Exemptions, Recordkeeping, & Penalties

Sponsored by: Kinnser SoftwareSeptember 24, 2010 – Orange, CA

This must-attend workshop will review the different wage orders and how they can affect your operations. It will include practice questions and exercises including a step-by-step analysis/discussion on how-to handle an

actual wage & hour claim. The last element will be a mock claim, discussing arguments for and against the claimant’s position, and group discussion.

Learning Objectives:Understand the basis of California’s wage & hour •laws – what they are and where they come fromUnderstand basics of exemptions – how does a •worker classify as exempt, whether an office worker or a caretakerUnderstand when extra pay is required – reporting •time pay, split shift pay; and when and how employers can charge for uniforms and equipmentUnderstand which employees are entitled to a meal •and/or rest period, and how to provide it to themUnderstand what records are required to be kept •regarding employees’ payroll (including paystubs) and hours worked, and how to make sure time is accurately reportedUnderstand what the potential consequences are •for failing to comply with Wage & Hour laws

For more information or to register for this workshop, please visit our website.

12 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

UPDATE

The Federal Trade Commission (FTC) will delay enforcement of the Red Flags Rule until December 31st, 2010. This Rule was created to ensure that

certain types of organizations are doing everything in their power to identify, prevent, and reduce incidences of identity theft. Most health care providers are subject to this Rule that requires businesses to develop identity theft programs tailored to the characteristics of their organizations. Although the FTC will not take any enforcement action before December 31, 2010, providers are still required to comply. (See information below regarding available materials.) There is, however, legislation pending in Congress that may change requirements to comply with the Rule.

Specifically, on October 8, 2009 H.R. 3763 was introduced into the House of Representatives. This proposed bill would amend the Fair Credit Reporting Act to exclude small businesses, including some health care providers, from Red Flags Rule requirements. This legislation was passed by the House of Representatives on October 21, 2009. It is currently being reviewed by the Senate Committee on Banking, Housing, and Urban Affairs. Section 1 of the proposed legislation provides as follows:

The Latest on the Red Flags Rule

F E AT

UR

ES

(4) EXCLUSION FOR CERTAIN SMALL BUSINESSES – For purposes of this subsection, the term ‘creditor’ shall not include—

(A) a health care practice with 20 or fewer employees;…or

(D) any other business, if the Commission determines, following an application for exclusion by such business, that such business—

i knows all of its customers or clients individually;

ii only performs services in or around the residences of its customers; or

iii has not experienced incidents of identity theft and identity theft is rare for businesses of that type.

(5) DEFINITIONS – For purposes of this subsection:

(A) EMPLOYEE – With respect to a business, the term ‘employee’ means any individual who works for such a business and is paid either wages or a salary.

(B) HEALTH CARE PRACTICE –

(iv) IN GENERAL – The term ‘health care practice’ means a business that’s primary service is providing health care via health care professionals employed by the business.

(v) HEALTH CARE PROFESSIONAL – For purposes of subparagraph (A), the term ‘health care professional’ means an individual engaged in providing health care and licensed under State law, including physicians, dentists, podiatrists, chiropractors, physical therapists, occupational therapists, marriage and family therapists, optometrists, speech therapists, language therapists, hearing therapists, and veterinarians

If this proposed legislation is enacted, the Red Flags rule may not apply to some providers. Some providers may also qualify for an exclusion from the Rule, as indicated above.

There’s always something new in healthcare!

©2010Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance

written permission of the author.

ADVERTISE & REACH

CA H S A H BU L L E T I N

For more information contact,Ranesh Maharaj

MORE THAN 1,800 HOME CARE

PROFESSIONALS EVERY MONTH

13www.cahsah.org

CAHSAH State Bill Tracking Priority A LegislationSTATE BILL WATCH PRIORITY A BILLSBill # Description Position Status

General BusinessAB 1735 (Harkey)

Would allow a tax credit in an amount equal to 50 percent of the amount of costs paid or incurred in connection with additional education and training for purposes of career advancement or retention, as specified.

Support Pending hearing. First hearing cancelled at request of author.

Health Care CoverageAB 2586 (Chesbro)

Would require a plan or an insurer that contracts with providers to obtain approval from its regulating dept. prior to implementing a network modification. Would require the plan or insurer, in order to obtain approval, to demonstrate that the modified network meets certain access requirements.

Support Referred to Appropriations Suspense File

Health Care PracticesSB 971(Pavley)

Would impose specified requirements on providers of blood clotting products for home use, as described, used for the treatment and prevention of symptoms associated with bleeding disorders, including all forms of hemophilia.

Oppose Unless

Amended

Senate Floor Third Reading

AB 950 (Hernandez)

Would allow in-patient beds as part of a hospice’s current license and not require the hospice to have a separate facility license.

Support Re-referred to Health Committee.

LaborAB 179 (Portantino)

CAHSAH sponsored bill to remove the weekly pay requirement. Would permit employees of temporary services employers of health care services to be paid semimonthly.

Support Re-referred to Labor and Industrial Relations Committee

AB 482 (Mendoza)

Would prohibit an employer, with the exception of certain financial institutions, from obtaining a consumer credit report for employment purposes unless the information is substantially job-related, and the position of the person for whom the report is sought is a position in the state Department of Justice, a managerial position, that of a sworn peace officer or other law enforcement position, or a position for which the information contained in the report is required to be disclosed by law or to be obtained by the employer.

Oppose Re-referred to Labor and Judiciary Committees

AB 1994 (Skinner)

Would provide, with respect to hospital employees, that the term "injury" includes a blood-borne infectious disease, neck or back impairment, methicillin-resistant Staphylococcus aureus (MRSA), or H1N1 influenza virus that develops or manifests itself during the period of the person's employment with the hospital. This bill could establish a precedent and open the door for home health to be included.

Oppose Referred to Appropriations Suspense File

AB 2187 (Arambula)

Creates a separate prohibition against a person or an employer who, willfully fails to pay all wages due to an employee who has been discharged or who has quit within 90 days of the date of the wages becoming due and would impose additional criminal penalties for such conduct. Also requires those who violate these provisions to pay restitution equal to the amount of unpaid wages to the aggrieved employee and prosecution costs, upon conviction becoming final.

Oppose Referred to Labor & Industrial Relations Committee

NursingSB 182 (Ashburn)

Would delete the limitation that temporary clinical nursing faculty be employed for not more than 4 semesters or 6 quarters.

Support Hearing cancelled at request of author.

State Funded ProgramsAB 1260 (Huffman)

CAHSAH sponsored bill to achieve the budget objective of $5.3 million in savings associated with cuts to respite services without applying an arbitrary and excessively restrictive cap.

Support Re-referred to Rules Committee

AB 1506 (Anderson)

Would require a state agency to accept, from any person or entity, a registered warrant or other similar evidence of indebtedness issued by the Controller endorsed by that payee, at full face value, for the payment of any obligations owed by that payee to that state agency.

Support Re-referred to Governmental Organization Committee

AB 1864 (Strickland, Audra)

Would provide that Medi-Cal providers be paid even when the state has not passed a budget for the current fiscal year.

Support Referred to Appropriations Suspense File

SB 886 (Florez)

Would authorize the providers of specified in-home services to use electronic timekeeping for verifying tasks completed and ensuring quality home care for in-home recipients, as defined.

Support Pending hearing in Human Services Committee

14

Federal Bill ListBill Number Description Position Location

AbuseS 795

(Hatch)Creates an Elder Justice Coordinating Council and an Advisory Board on elder abuse, neglect and exploitation which will be responsible for coordinating public and private activities and programs related to elder abuse

Watch Referred to Finance Committee

Health Care CoverageH.R. 3590(Rangel)

Senate version of health care reform, referred to as the Patient Protection and Affordable Care Act (PPACA),

Watch Signed by the President

S. 3315(Collins)

Amends the Patient Protection and Affordable Care Act with respect to the prospective payment system for home health services and adjustments for case mix changes. Requires beginning 2011 and each subsequent year that any evaluation of case mix changes and any such adjustment be made using standards developed consistent with specified processes, taking certain criteria into account. Directs the Secretary to convene a Technical Advisory Group to advise on the development of such standards.

Watch Referred to Finance Committee

Health Care WorkforceH.R.468

(Schakowsky)S.245 (Kohl)

Expands training and support to all sectors of the health care workforce to care for the growing population of older individuals in the United States.

Watch Referred to House Education and Labor Committee

S 631(Kohl)

Establishes a pilot project to identify efficient, and economical procedures for long-term care facilities or providers to conduct background checks on prospective direct patient access employees on a nationwide basis under similar terms and sets requirements for states participating by requiring: searches of neglect registries and databases; searches of proceedings that may contain disqualifying information; searches of federal criminal history records, including fingerprint check and ways to reduce duplicative fingerprinting.

Watch Referred to Senate Finance Committee

Home HealthHR 1094(Lewis)

Permits a home health agency to determine the most appropriate skilled service to make the initial assessment visit for an individual who is eligible for home health services under Medicare but does not require skilled nursing care as long as that skilled service is included as part of the plan of care for such services.

Watch Referred to House Energy & Commerce Committee

H.R.1765 (Matsui)

Amends Title XVIII of the Social Security Act for payment of furnishing intravenous immune globulin in a patient's home for the treatment of primary immune deficiency diseases and covers certain disposable pumps as durable medical equipment under the Medicare.

Watch Referred to House Ways & Means Committee

S. 1123(Collins)

Would restore the 5 percent add-on for Medicare home health services delivered in rural areas. The most recent iteration of the rural add-on expired at the end of 2006, and this bill seeks to reinstate the add-on payment for five years beginning Jan. 1, 2010.

Support Referred to Senate Finance Committee.

S. 1157(Conrad)

Would protect and preserve access for Medicare beneficiaries in rural areas to health care providers under the Medicare program and reinstate the 5 percent Medicare home health rural add-on for calendar year 2010.

Support Referred to Senate Finance Committee

H.R. 3030(Waltz)

Would set up pilot projects through the Department of Health and Human Services to provide incentives for home health agencies to use remote monitoring technologies and identifies various performance targets for participating home health agencies to meet and mandates that incentive payments be given to participating home health agencies based on having met performance targets.

Support Referred to House Energy and Commerce Committee

Home InfusionHR 574 (Engel)S.254 (Lincoln)

Amends title XVIII of the Social Security Act to provide for the coverage of home infusion therapy under the Medicare Program.

Support Referred to House Ways & Means Committee

HospiceS.421

(Specter) Imposes a temporary moratorium on the phase out of the Medicare hospice budget neutrality adjustment factor.

Watch Referred to Senate Finance Committee

S.1150 (Rockefeller)

Would make hospice a required benefit under Medicaid and the Children's Health Insurance Program (CHIP), and for children, requiring concurrent coverage of both hospice and curative treatment.

Support Referred to Senate Finance Committee

Information Technology/TelemedicineHR 2068

(Thompson)Removes current geographic restrictions on the provision of telehealth services furnished via a telecommunication system by a physician to an enrolled individual. Authorizes payment of eligible telehealth providers or suppliers other than a physician or telemedicine practitioner.

Watch Referred to House Committee on Energy and Commerce, and Committee on Ways and Means

MedicareH.R.27

(Biggert)Amends title XVIII of the Social Security Act establishing additional provisions to combat waste, fraud, and abuse within the Medicare Program.

Watch Referred to House Judiciary

H.R.902 (Smith, A.)S.712(Feingold)

Amends title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in rural areas.

Watch Referred to House Energy & Commerce Committee

CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

Better Outcomes Through Standardized Patient CareNEW Automated Rules Management Feature

McKesson Supply Management Online now offers Automated Rules Management to help control costs while increasing efficiency.

The technology you already use, Supply Management Online, makes rules management easy for you. With this new feature, you can now enhance quality of care while monitoring and reducing unnecessary costs, all with a simple set-up.

Rules management is a tool for you to:

Supply Management Online helps you to execute your strategies and comply with Prospective Payment System (PPS) requirements simply while reducing waste and controlling costs.

To learn more about how to streamline patient care and simplify staff use of supplies, contact McKesson Medical-Surgical today at 888.822.8111.

McKesson Medical-Surgical8741 Landmark RoadRichmond, VA 23228888.822.8111

www.mckesson.com

©2008 McKesson Medical-Surgical Inc.2008-0077

Supply Management Online’s new rules management feature helps you:

Manage protocols according –to your pre-established guidelines Monitor appropriateness of –product use Track adherence to protocol –guidelinesAchieve cost savings –

Manage supply costs for patients – Control products purchased by clinicians –Avoid over-utilization of products –

Limit products purchased to –approved formulary Reduce chances of non-reimbursement –