As of July 1, 1998, anyone practicing social work or holding him or herself out as a social worker in the state of Colorado must be licensed by the State Board of Social Workers Examiners. The legislation, House Bill 98-1072, called for rules to be written by the board in order to implement the statute. These rules are reportedly completed but have not been published as of press time. Interested persons can call Karen Frazzini at the State Board at (303) 894-7767 for a copy of the final rule. 

The proposed regulations were circulated early this spring to all interested parties and a public hearing was held on March 12th. In her testimony on behalf of HCAC’s 120 member agencies, Executive Director Ellen Caruso noted that the Colorado Legislature has determined that there is a need for additional regulation of social workers in Colorado in order to protect the public.  

Caruso told the board that as an organization of companies that provide medical social work services, "HCAC is concerned with any statute or rule which mandates additional regulations which may impact our employees by requiring further education, supervision, testing or licensure; raise the cost of health care due to actual cost to the company or a subsequent increase in salaries to cover the costs of meeting the new standard; or make it difficult or impossible for agencies to continue to provide necessary services to our clients.” She asked the board to keep an open door with the home care industry “so we don’t end up hurting the client/consumer that the legislature was trying to protect with this legislation.” 

She also submitted written testimony that was developed jointly by HCAC and the Colorado Hospice Organization. (See related article in the Winter 1999 issue of the management report.)  
 

Carolyn Glider, provider relations manager for the new fiscal agent for Colorado Medicaid, addressed home care issues during a meeting with HCAC’s Reimbursement/Regulatory Council on March 23rd. Issues that have been or are being resolved by Consultec include: 

~~ Incorrect rates for HCBS personal care provider services 
~~ Prior Authorization Requests (PARs) with wrong dates, wrong rates and delayed payment  
~~ Claims “in process” so never deny 
~~ Refusal to pay certain codes like Mentally Ill and Home Modifications 
~~ Denials  
~~ Timely filing  
~~ Code 27 

~~ read the first page of the remittance statement which will notify you of claims being “reprocessed”  
~~ make sure that Consultec’s newsletters are distributed to the correct person(s) at your agency 
~~ submit 10 to 15 line claims rather than 22 lines (more lines create more information editing conditions) 
~~ code 27 is still required even though a service plan is no longer required 
~~ arrange training on WINASAP software by calling (303) 534-0146 or (800) 237-0757

HCFA announced on April 7th that it was delaying home health agencies’ OASIS data transmission from April 26, 1999 to a date to be announced. The agency waited 20 days to make the critical announcement that it had also delayed mandatory collection, use and encoding. New deadlines will be no earlier than 30 days after a “system of records” is published in the Federal Register. This notice will describe how patient privacy will be protected. 

It is unknown at press time if the requirement to collect information on private pay clients is about to be changed or totally rescinded, and what to do when a patient refuses to provide OASIS information. 

The new effective date for transmission of data as well as other up the minute information on OASIS requirements will be posted on HCFA’s OASIS webpage at www.hcfa.gov/medicare/hsqb/oasis/hhnew.htm. HCFA’s April 27th notice to providers is printed in full and included with this issue of the management report. 

(Ed. Note: The National Association for Home Care reminds home care agencies that suspension of OASIS data requirements is probably temporary. Once HCFA receives an Office of Management and Budget number for the OASIS data set and publishes the system of records regulation, enforcement of OASIS will most likely be reinstated. This delay offers an excellent opportunity to agency staff to become familiar with the OASIS data as part of the comprehensive assessment. In addition, agencies can evaluate ways to use the OASIS data for measuring outcomes and improving their own agency performance – the primary purpose of collecting OASIS data.) 

The sequential processing and payment policies which have caused serious cash flow problems over the last year for home health agencies nationwide will be history on July 1st. The shift of payment for home health visits from Part A to Part B of the trust fund after 100 visits, as mandated by the Balanced Budget Act of 1997, remains in effect. In a  memorandum to providers, HCFA told providers that “the first one hundred visits will be counted in the order in which they are processed” and providers are encouraged to “continue to submit claims in sequence in order to prevent the need for later adjustments.” 

(Ed. Note: Sequential billing remains in place for Hospice providers. Hospice providers are asked to report via fax to HCAC any negative 

financial impacts due to sequential billing. Please fax comments to (303) 694-4869.) 
 
 

After increased reports of the problems home health agencies were having with HAVEN software, including corrupted data upon encoding, the developers of HAVEN have promised a fix by June 1, 1999. 

According to Fu Associates, the HCFA contractor that developed HAVEN software for OASIS, the problems with version 1.03 will be 99 percent resolved in version 2.0. This version will be released on the HCFA website (www.hcfa.gov). Agencies will be able to order the CD-ROM once the updated version is posted on the website. 

The Hospice Cost Report has been approved by the Office of Management and Budget and will be posted on the HCFA website shortly (www.hcfa.gov). 
 
 

During a recent trip to the National Association for Home Care’s 1999 Policy Conference and Legal Symposium in Washington, D.C., I gained a great deal of knowledge and encouragement that we in Colorado are far from alone in our efforts to maintain viability of our home care industry. The American Federation of Home Health Agencies, the Home Health Association of America, the Home Health Services and Staffing Association, the Visiting Nurse Association of America and NAHC have come together to support a unified message to Congress to enact legislation that: 

~~Restores access to home care for patients with medically complex conditions. 
~~Ensures that a prospective payment system is implemented on October 1, 2000, and includes incentives for home care agencies to provide medically necessary services to all eligible individuals. 
~~Eliminates the mandatory 15 percent cut scheduled for October 1, 2000. 
~~Eliminates the retroactive per beneficiary limits which result in “overpayments,” creating financial instability in the home care delivery system. 
~~Increases the per-visit cost limit. 
~~Ensures beneficiary choice of home health provider by modifying the proration provision.

Our own Wellmark has sustained significant losses as well from reduced claims with reduced services provided from fewer agencies. Meeting with the health aides from Colorado’s elected contingent, it was apparent that our story is indeed impacting more than the budget deficits and Medicare spending growth. What we need to relay is the beneficiary’s viewpoint as well: how has this affected their care? How many jobs have been eliminated? What are the reductions in payroll (and taxes)? What effect is the IPS per beneficiary limit overpayments having on the surviving agencies? An incomplete tally of agencies closed since enactment of the BBA 1997 is 1111 throughout the United States through February 1999. We know there are more every day, especially since overpayment notices have been generated for those on a fiscal year ending October through December 1998. 

Throughout our industry, however, there is a great deal of hope, not just commiseration, of surviving and yes, even growing our business. Other state associations relay ingenuity and creativity among their membership in developing new companies and partnerships to care for home care recipients. New home care companies are springing up in Colorado. What we previously thought was business not worth going after is now perceived as lucrative and hassle-free business in comparison. Private pay and specialty programs are on the increase more so than ever before. Any type of care not associated with or reimbursed by Medicare and Medicaid is being considered. Wellness and preventive care packages, adult day care and assisted living partnerships are some of the creative avenues targeted by some state association members. 

Our industry is and will be chaotic and changing daily if not more often. Our approach and tactic is to be proactive with our legislators, policy makers, strategic planners, information systems analysts, and ourselves in developing newer approaches to home care. Our creativity and ingenuity will need to drive our growth, not the systems that confine our thinking to what is and has always been. After all, our older population will continue to grow and want to remain at home as long as possible. We will be these people. 
 

Welcome to the following new Provider member who has joined HCAC since the last publication of the management report: 

~~ Care 4 Health, 2445 S. Quebec Street, Denver, CO 80231 
 (303) 756-9489

~~ Healthcare Employment Screening, 4110 S. 100th East Avenue, Tulsa,   OK 74146-3639  (888) 707-8437  (pre-employment background   checks) 

~~ Burns Wall Smith & Mueller, 303 East 17th Avenue #800, Denver,    CO 80203-1260  (303) 830-7000  (health care law firm)

As a professional home health social worker and a member of the Colorado Chapter of the National Association of Social Work I feel compelled to respond to your recent article regarding social work licensure. HB 98-1072 was the first step taken toward regulating the practice of social work and bringing some credibility to the profession. Prior to the passage of this bill, anyone could call themselves a “social worker.” I have sat through many a community meeting listening to people speak that introduced themselves as a social worker and what they were saying was in direct conflict with the social work code of ethics. Many times this person had never taken a social work course and had not a clue what the basis of the profession stands for. 

By licensing social workers we hope to bring the standard up. Nurses and doctors have been licensed for years. I imagine that at the time they were first mandated to pass a test and get a license many of them were in opposition to it. The first step is always the hardest. In response to your question regarding how can a social worker prove competence (who) has been out of school for years, the answer is simple: pass a test. There are many review courses available. If they cannot pass a test maybe they aren’t as competent as they lead you to believe. The major opposition to this bill was by the medical profession, an industry that has regulated itself and practiced licensure for years. 

Kendra Kinney, LCSW 
Continue Care Home Health, Montrose 

(Editor’s Note: The above letter was in response to an article on social worker licensure that appeared in the Winter 1999 issue of the management report. The article outlined issues that the home care industry had identified in the proposed rules and regulations governing the licensure of social workers and the anticipated increased costs to home care agencies due to the increased regulation and oversight required to comply with HB 98-1072.) 

~~ Accepted the HCAC December 31, 1998 finance report that indicated that slightly more than $2,000 was added to the association’s reserves at year end. 
~~ Heard the summary results of the annual management team Continuous Quality Improvement survey covering the period of January 1, 1998 to December 31, 1998. The overall score for Executive Director Ellen Caruso and her staff was 4.32 on a scale of 1 to 5. 
~~ Voted to change the size of the board from a range of 15 to 17 to a range of 13 to 17 members. 
~~ Appointed Judi DeVore, Colorado Home Care/Greeley, as vice president to fill the unexpired term of Erin Denholm, Centura Home Health & Hospice/State, who resigned due to board policy that only allows one person from a member agency to serve as an officer at any one time. 
~~ Accepted the resignation from the board of Larry Lillo, formerly of Summit Home Health/Englewood, who has changed positions. 

Theresa Y. Jamison, RN, from Parker, has been appointed to the Colorado State Board of Nursing by newly elected Gov. Bill Owens.  Jamison is a staff nurse at the Visiting Nurse Association of Denver. She will fill the position that has been especially designated for a “licensed professional nurse engaged in home health care.” Jamison replaces Susan Grayson, Centura Home Health & Hospice, Denver, who was the first home health nurse to serve on the Board of Nursing. 

Ninety six persons from the home care community gave HCAC’s “What’s New in Medicare” seminar on March 30th high marks. All attendees learned how to apply the Conditions of Participation as a foundation for Quality Assurance; heard what is expected to be included in the new Prospective Payment system; and heard two perspectives on fraud and abuse compliance from an assistant U.S. Attorney General and a local attorney specializing in health care law. Then attendees spent the entire afternoon either learning about clinical documentation and compliance or calculating their agency’s cost per patient and cost per visit. 

Following is a sample patient notice and authorization form that was developed by attorneys Bill Dombi of NAHC staff and Gene Tischer of Associated Home Health Industries of Florida. Keeping in mind current changes in OASIS regulations, HCAC members are encouraged to modify and use this notice at which time it may be appropriate. 

Collection, Use of, and Authorization to,  
Release Patient/Client Information 
 

XYZ home health agency (herein XYZ) meets the Medicare Conditions of  Participation. These Conditions, promulgated by the Health Care Financing  Administration (HCFA), require XYZ to collect health care information and data on all patients admitted to our agency, regardless of whether they are enrolled  in Medicare or not. The actual information we must gather is mandated by HCFA’s  Outcome and Assessment Information Set (OASIS). Furthermore, HCFA directs us to  collect this information at specific times during the course of your care. The  OASIS information is transmitted to the Dept. of Public Health & Environment (DPHE), a state agency, and then retransmitted to HCFA. The information is to be used to evaluate and report on the quality of home health  services. 

XYZ needs your permission to collect OASIS information from you and transmit it to DPHE and have it further transmitted to HCFA. These  government agencies assure us that patient identifiable OASIS information will not be released to the public by either agency. We assure you that we, and any agent acting on our behalf, will not release this information, except as  specifically authorized by you. While there are no penalties, as such, for refusing to supply OASIS information or authorize the release of that  information, there is one serious adverse consequence. HCFA will not permit XYZ  to provide services to you if you fail to furnish the OASIS information or authorize its release. 

PATIENT AUTHORIZATION  

I authorize XYZ home health agency and its agents to release to the Health Care Financing Administration or its agents any information contained or included in the Outcome and Assessment Information Set (OASIS). I permit a copy of the authorization to be used in place of the original.  

_____________________________________ (Signed)  

__________________________(Dated)