Selecting An
Broker: P. 6
CAHSAH Bulletin
Volume 26, Number 09
Companion Care Exemption
Under Close Examination
iven recent lawsuits and proposed legislation surrounding the
companionship exemption, it is no surprise that many home care
owners are taking steps to make sure that they are paying their
caregivers properly. CAHSAH has seen an increase in inquiries on how
to apply the personal attendant exemption, and how to structure wages for liveins and caregivers who work more than eight hours in a day. CAHSAH has taken
a strong leadership position at the state and federal levels with this issue and
has developed this informational article in an effort to help answer some of our
members’ questions.
Understanding the complex dynamics involved in the personal attendant
exemption requires careful consideration of the provisions in Wage Order 15 California’s Wage Order that regulates home care workers. CAHSAH educates owners
who are new to the home care industry as to the law’s application, which allows an
exemption from having to pay overtime.
Cover Story: Exemption, continues on p. 4
(N.Y.): P. 12
Home Care
Indicted for
P. 14
The CAHSAH Bulletin
is brought to you by
Learn more by going to
s the end of the legislative
session draws near with
Governor Schwarzenegger’s
September 30 constitutional deadline
to either sign or veto all bills, CAHSAH
takes a step back to reflect on the
legislative successes and challenges of
As has become expected in California,
an enormous number of bills were
introduced by both the state Senate and
Assembly (2261 in total), and CAHSAH’s
first task was to review every bill and
determine whether or not it impacted
the home care industry. The Policy,
Advocacy, and Public Affairs (PAPA)
Committee, chaired by Lucy Andrews
of Heart of Home Care, impressively
triaged these bills down to 50 priority
items, with 16 marked as high priority.
These bills involved issues varying from
workers’ compensation to nurse training
to licensing, and each have taken
various paths to the Governor’s desk.
In the end four out of the six priority
bills that CAHSAH opposed died while
the other two still await the Governor’s
decision. The following is a highlight
of a few of the priority bills and
CAHSAH’s involvement with them:
2010 Legislative Wrap-Up
AB 179 (Portantino): This bill was sponsored by CAHSAH and aimed
to resolve the uncertainty surrounding weekly pay requirements that
was created by SB 940. Specifically, the bill sought to allow home
care companies to pay their employees every other week as opposed
to every week. This bill encountered significant opposition from
organized labor and especially from the California Nurses Association,
and ultimately failed in the Senate policy committee.
SB 971 (Pavley): This bill focuses on the providers of blood clotting
products, and in its original form would have made it nearly
impossible for smaller home infusion providers to comply with the
requirements. CAHSAH intervened and was able to get the author
to agree to amendments that removed the onerous requirements,
thus allowing our home infusion members to continue to provide this
AB 950 (Hernandez): CAHSAH supported this bill which would have
changed the hospice licensing provisions to allow for the licensing
of hospice facilities. The bill encountered concern and ultimate
opposition from a few legislators in key positions on committees
which killed the bill. CAHSAH intends to revisit this issue in 2011.
AB 1994 (Skinner): CAHSAH strongly opposed this bill, which would
have presumed that a hospital was liable for all injuries of hospital
employees regardless if the injuries happened at the hospital or not. If
this bill passed CAHSAH fully expected the same proposal to be aimed
at the home care industry in the following years. CAHSAH aligned
itself with the CalChamber and was able to kill the bill in committee.
W NU H ea d lin es
SEPTEMBER 6TH: CMS Continues ADR Probes for Home
Health and Hospice
CAHSAH members continue to bring to our attention the
prevalence and severity of Additional Development Requests
(ADRs) that CMS has been relentlessly pursuing. Last week,
the CAHSAH Forum discussed the frequency and types of ADR
probes that they have been experiencing.
Click here for the full article.
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SEPTEMBER 13TH: U.S. Guidance Issued on Hospice Care for
Children in Medicaid and CHIP
Last week, the Centers for Medicare and Medicaid Services
provided guidance on removing the prohibition of receiving
curative treatment upon the election of the hospice benefit
by or on behalf of a Medicaid or Children’s Health Insurance
Program (CHIP) eligible child under the Affordable Care Act,
the new healthcare reform legislation.
Click here for the full article.
SEPTEMBER 20TH: The Medicare Agencies Call to Action!
Two very important bills have been introduced at the federal
level in an effort to minimize the effect of the unprecedented
payment cuts that are proposed in the CMS 2011 home health
payment rule. S. 3315; H.R. 5803 also called the Home Health
Care Access Protection Act were introduced by Senator Susan
Collins and Representative James McGovern.
Click here for the full article.
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Medicare-certified home health agencies are reminded that
unless they qualify for an exemption from participating in the
Home Health Care CAHPS (HHCAHPS) Survey for the 2012
Annual Payment Update (APU), they must conduct a dry run
of the HHCAHPS Survey for at least one month in the third
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Chair’s Message
Barry Berger
Making CAHSAH and Home Care More Visible
hope everyone had a great summer. As the season changes
to fall, it marks the beginning of two important events
for all Americans, the start of the football season, and the
beginning of the fall election campaign. I hope all of you
participate and support these activities.
Part of my personal mission over the next two years is to make
CAHSAH specifically, and the Home Care Industry more visible
within the health care and referral community. One of the
ways we are accomplishing this, is to participate and exhibit in
various trade shows. In October, CAHSAH will have a display
at the Western Regional Chapter of the National Association
of Private Geriatric Case Managers in Costa Mesa, and another
display at The Ventura County Home Care Association annual
one day conference.
We are hoping that we have the same success that we had
when we exhibited at the Society for Social Work Leadership
in Health Care last May. We had the opportunity to discuss
CAHSAH with many of the department heads of Social Work
at the major hospitals in Southern California. The participants
were happy to receive the CAHSAH Resource Guide along
with information regarding the CAHSAH Home Care Aide
certification program. We will be happy to look into other
trade shows as they come to our attention. Feel free to email
me with any suggestions you may have.
September was a very busy month for CAHSAH. Our education
committee reviewed over 80 proposals for speakers for our
2011 Annual Conference in May to be held in Ontario. I am
pleased with the selection and variety of both Keynote and
Breakout sessions the committee put together. Additionally,
the education committee put the finishing touches on our
Executive Home Care and Hospice Exams. A group of CAHSAH
members spent over 4 days planning and writing the test. The
end result is a product that will be administered around the
country which will add to the reputation and credibility of
Our legislative committee has been extremely busy this past
month as they gear up for both the state and federal legislative
sessions. Issues regarding all areas of CAHSAH from Home Care
Aide, Hospice, and Medicare Certified are being discussed and
strategy to address the areas are being planned.
During the month of September, a group of six providers met
with Congresswoman Linda Sanchez to discuss her federal bill
that will eliminate the companion exemption that currently
allows the home care aide industry a reprieve from paying our
employees overtime. Our goal with the congresswoman is to
first educate her on the necessity to continue the exemption,
and then work with her on the final draft of the bill.
Please call or e-mail me with any suggestions or concerns you
may have. The Board along with the CAHSAH staff values the
input from our members.
Barry Berger
[email protected]
818-986-1234 x101
CAHSAH Bulletin
Published by CAHSAH
Joseph H. Hafkenschiel, President
California Association
for Health Services at Home
3780 Rosin Court, Suite 190 Sacramento, CA 95834
Telephone: (916) 641-5795 Fax: (916) 641-5881
For advertising and
sponsorship information,
please contact:
Ranesh Maharaj,
Bulletin Editor
E-mail: [email protected]
(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.
Reviving Up Grassroots Efforts
for the Home Health Protection Act
ital legislation is pending at the
federal level that could rectify the
unprecedented payment cuts which
were proposed in the CMS 2011
home health payment rule.
S. 3315; H.R. 5803 known
as the Home Health Care
Access Protection Act were
introduced by Senator Susan
Collins and Representative
James McGovern to establish
a fairer and more transparent
process for evaluating case
mix changes. A nationwide
grassroots campaign
composed of State home health associations,
AARP and other community coalitions has
been established to target each state’s
congressional members. It is critical that these
bills receive enough congressional members
to add on as co-sponsors in order for the bills
to receive a legislative hearing.
CAHSAH would like to thank those Medicare
home health agencies that have already
sent e-mails through our Legislative Action
Network asking their congressional members
to co-sponsor the Home Health Protection
Act. California agencies have sent over 400
electronic letters but we
still have CA congressional
members that have yet to
be contacted and told how
essential these bills are in
preserving access to home
health services. We need
your help in getting every
California congressional
member to sign on to
these bills. Talking points
and background information on the bills
is here. A preformatted letter has been
prepared which we encourage you to add
your specific agency’s details. You can locate
your congressional member and send the
letter here. Please provide feedback to the
CAHSAH office if you receive a response back
from your congressional member. Tracking
our grassroots efforts is vital to achieving our
advocacy goals.
Exemption, continued from p. 1
Those who have been in the business for a
longer period of time may still struggle to
understand its complexities. Wherever you
are in this spectrum, it is critically important
to utilize the exemption carefully and
First and foremost, caregiver job descriptions
should be consistent with the Wage Order 15
definition for a personal attendant which is
defined in Section 2(J) of the order as:
“Personal attendant” includes baby sitters and means
any person employed by a private householder or by
any third party employer recognized in the health care
industry to work in a private household, to supervise,
feed, or dress a child or person who by reason of
advanced age, physical disability, or mental deficiency
needs supervision. The status of “personal attendant”
shall apply when no significant amount of work other
than the foregoing is required.
Another key to understanding this definition
is the term “no significant amount of work.”
CAHSAH was instrumental in receiving an
opinion from the California Department of
Labor Standards and Enforcement (DLSE)
on exactly what is meant by “significant”.
The opinion (click here) clarifies the duties
that may be performed and provides
detail on the amount of household chores
that are allowable under the exemption.
Specifically, the opinion states that “any
general housekeeping duties performed
should not exceed 20 percent of the
weekly working time spent by the personal
attendant to maintain his or her exemption
under IWC Wage Order 15.” Ensuring that
your caregivers stay within the 20 percent
rule requires accurate recordkeeping of
caregivers’ daily tasks. This documentation
will be very valuable in the event that a
caregiver or other person or entity seeks to
challenge your use of the exemption. If the
caregiver does not meet this definition under
Wage Order 15, home care owners should
determine whether the employee may
satisfy another exemption under Wage Order
4 or 5. Other exemptions include individuals
who are qualified as “Administrative” or
“Executive” employees, as those terms are
defined in Section 1 of the Wage Orders.
Exemption, continues on p. 5
Exemption, continued from p. 4
If the job description and job duties fall under the definition
of Personal Attendant under Wage Order 15, then the
employer may not have to pay overtime or provide
meal and rest periods. The ability to provide twenty-four
hour care to a client without overtime allows owners
to preserve continuity of affordable care and establish
good caregiver relationships with their clients. While the
exemption removes the requirement of overtime pay for
this classification of worker, an employer must still ensure
that they are paying the caregiver for all hours worked at
California’s current minimum wage of $8.00 per hour. This
is another sticky area, with which employers struggle to
structure wages for caregivers that provide live-in care or
otherwise work more than eight hours a day. While Wage
Order 15 does provide a definition for “hours worked,”
that definition may be subject to differing interpretations.
Wage Order 15 defines “hours worked” as “the time during
which an employee is subject to the control of an employer,
and includes all the time the employee is suffered or
permitted to work, whether or not required to do so.”
Some interpret “subject to the control of employer” as all
hours that the caregiver is in the home; others interpret it
as only hours actually worked. The Fair Labor Standards
Act, the federal counterpart to the California Labor Code,
also defines “hours worked” such that home caregivers
are exempt from overtime and minimum wage. We hope
to receive clarification from the California Department of
Labor Standards Enforcement regarding this issue, and will
update our members as soon as we have any additional
CAHSAH also has been working to preserve the federal
companionship exemption, which is currently being
questioned by Congresswoman Linda Sanchez (D-CA) and
others in the federal government. Preserving the overtime
exemption for home care workers has been a central
issue of CAHSAH’s 2010 advocacy efforts. A workgroup,
comprised of CAHSAH members and staff, has been
formed to develop strategies and already has met with
Congresswoman Sanchez. CAHSAH also has met with a
Representative of George Miller’s office, Chairman of the
Congressional Health, Education, and Labor Committee, to
discuss CAHSAH’s concerns regarding a proposal from Labor
Secretary Hilda Solis to remove the exemption through a
proposed change to current regulations. Whether the issue
surfaces in legislation or regulation, CAHSAH will continue
to advocate for a solution that protects our members, their
employees, and all home-care clients for whom continuity
of affordable care is paramount. If you have questions
about our advocacy efforts, please contact Jordan Lindsey,
Policy Director at (916) 641-5795 ext: 123 or [email protected]
Elizabeth H. Murphy, Esq. is a CAHSAH affiliate
and a specialist in home care employment issues and can be
reached at (213) 683-5276 or [email protected]
Ask Mary
Answering your legislative
& compliance questions
uestions: When certifying /recertifying hospice patients,
must a physician provide an oral narrative as part of an
oral certification /recertification, if the written certification /
recertification cannot be completed within two calendar days?
nswer: From Medicare Hospice Center Q&A, the oral
certification/recertification should state that the
patient is terminally ill with a life expectancy of 6 months
or less, if the illness runs its normal course. Currently, we
do not require the narrative to be provided orally at the
same time as the oral certification /recertification. However,
we would remind certifying/recertifying physicians and
hospices, that while the narrative (verbal or otherwise) is
not required as part of the oral certification/recertification,
the essence of what the written narrative will ultimately
entail in its explanation of the clinical findings that support
a life expectancy of 6 months or less, is expected to be the
basis for the oral certification/recertification. While a verbal
narrative is not required as part of the oral certification/
recertification, the written narrative is required prior to
filing a claim.
uestion: Is there a Medicare Condition of Participation
regulation which requires a Medicare certified agency to
provide at least one skilled service in its “entirety” by employees of
the agency and does it prohibit an agency from contracting with
staff for that category of service?
nswer: From the Medicare Conditions of Participation
§484.14(a) Standard: Services Furnished specifies: Parttime or intermittent skilled nursing services and at least one
other therapeutic service (physical, speech or occupational
therapy; medical social services; or home health aide
services) are made available on a visiting basis, in a place of
residence used as a patient’s home. An HHA must provide at
least one of the qualifying services directly through agency
employees, but may provide the second qualifying service
and additional services under arrangements with another
agency or organization.
An HHA is considered to provide a service “directly” when
the person providing the service for the HHA is an HHA
employee. For purposes of meeting 42 CFR 484.14(a), an
individual who works for the HHA on an hourly or per-visit
basis may be considered an agency employee if the HHA
is required to issue a form W-2 on his/her behalf. An HHA
is considered to provide a service “under arrangements”
when the HHA provides the service through contractual
or affiliation arrangements with other agencies or
organizations, or with an individual(s) who is not an HHA
Selecting an Insurance Broker
They’re All the Same, Right?
n today’s work place, there are two decisions that every
company faces when renewing their insurance: which
carrier to select and more importantly, which insurance
broker to use. Many consumers are under the false belief
that all insurance brokers are created equal and have access
to the same insurance carriers and can obtain the same
coverage and pricing from those carriers. While, in theory,
insurance companies are supposed to provide the same
coverage, pricing and rates to each broker, this is not always
the case.
There are a variety of reasons why one broker might get
better coverage and pricing than another broker for a
particular insured. The major reasons include: brokers
who specialize in your industry and whom have greater
knowledge to provide a more comprehensive submission
to the insurance company can negotiate better terms.
Additionally, brokers who have exclusive or limited access
programs not available to all brokers can drive down pricing
and brokers who have stronger relationships with the
carriers can utilize that relationship to the betterment of
the client. It is important to determine if your broker has
these advantages that will ultimately benefit you with better
coverage and lower premiums. There are also other cost
reducing services to consider that brokers can provide and
implement, which I will touch on later in this article.
Some companies prefer
to use a local broker, but
when most buyers are
asked how many times
they see their broker, it
usually ranges between
1-4 times a year, if at
all. Another common
response from consumers
is they want to support
the local community.
While it might be nice
to support your local
economy and community,
it should not be at the
expense of having
inadequate insurance
protection at an inflated
cost. There are many
ways for your company
to support the local
economy and community
which will help your
company receive positive
recognition while being a
valuable marketing tool to
you as well. If you do have
a desire to select a local
broker, it is imperative to
By Steve Parkhurst, Heffernan Insurance Brokers
make sure you compare them versus a broker that has the
corporate size, market access and industry knowledge to
create competition during the quoting process so you can
evaluate and compare the two options.
So how do you select the right broker? There are a few ways
to go about it. One way is to interview a few brokers 4 to 5
months before your renewal date. Decide on which broker
is best suited to handle your needs and also has specific
industry programs, services, and attentiveness which you
desire. The broker needs to be able to audit your operations
and insurance coverage to ensure they align and there are
no gaps in protection. The broker also needs to be able to
prepare a comprehensive report to market your account
to insurance carriers in the best light and provide the most
competitive insurance quotations due to the presentation
and relationship the broker enjoys with the carriers. The
right broker should bring a few carrier options to the table
at renewal time and include their opinions and input on the
different quotes and companies, while letting you make the
final decision.
nother approach is to select two of the brokers
interviewed and let them select their markets/
carriers and compete for your business. That way
the brokers will each have several markets to work
with on your account and feel they have a reasonable chance
of working with your company. By giving a broker a good
opportunity to work with your company, they will invest the
time, energy and commit the resources in creating the best
product for your firm. Creating this competition and taking
coverage, price and services into consideration, ultimately will
land your company with the right broker and carrier.
If you ask any insurance sales person, they will tell you
that their brokerage firm is the best fit for your company.
However, in addition to their experience and market clout,
what really makes a broker the most valuable to your
company are the services behind the scenes.
Three essential services should be offered by the most
qualified brokerage firm; they are Loss Control, Claims
Management and HR Consulting.
Loss Control is crucial to prevent unwanted and “Lazy
claims” that can arise by lack of knowledge and know how.
Loss Control includes location review & assessments, review
of employee hiring guidelines and handbooks, review of
your Injury Illness Prevention Program and other policies,
procedures and requirements that your company has in
place for your employees. When properly implemented and
maintained, a comprehensive Loss Control program will
lower the number of claims that occur and increase employee
awareness of safety in the workplace.
Essential, continues on p.7
Essential, continued from p.6
The second service your broker should offer is Claims
Management. Claims Management is designed to monitor
and expedite the closure of open claims while keeping an
eye on reserve amounts to eliminate over reserves by the
insurance company, as well as to push claims to close as
quickly as possible. By monitoring claims reserves, which
are sometimes over stated, you are assured that they are
kept at the appropriate level and don’t negatively affect your
company claims experience which can drive up your ultimate
insurance costs. Aggressive claims management will help
reduce your experience modification because it keeps the
claims total cost down which is used in the calculation.
Let Heffernan
take care of
the insurance.
The third service that your broker should offer is HR
consulting and hotline. This is a tool that can be a life
saver for any company. When dealing with firing, hiring or
sensitive employee issues the HR hotline can be called to
make sure that the proper steps are utilized to prevent any
retaliation or inappropriate HR decisions. All of these tools
should be offered by your broker to ensure that you are
getting the “bells & whistles” that go along with established
liability and more, Heffernan has
So you can focus on what you
do best. Specialists in home care
insurance, offering workers comp,
worked with CAHSAH for over
15 years. Contact Melani Conti
at [email protected] or
John Prichard, Jr. at johnpjr
In addition to the three essential services described above,
it is also very helpful for your broker to offer other ancillary
services such as Health Benefits, 401-k and Retirement Plans,
The bottom line is your broker needs to have the expertise,
industry knowledge, niche programs and utilize their overall
market clout to get the job done for you. Look for a broker
that you trust and aligns with your company to offer the best
options for your company year in and year out.
For more information on selecting the right broker, feel free to contact
me at: [email protected] or visit our website at
Considering Telehealth?
he Eddy Visiting Nurse Association, a not-for-profit
home health care agency based in Troy, New York,
recently completed a one-year pilot study that
identified several significant benefits resulting from
the utilization of telehomecare intervention, including a
dramatic drop in the rate of patient hospitalizations (55
percent), emergency room visits (29 percent), and total
medical costs (42 percent).
They are now refining their telehomecare discharge plan and
devising a way to empower patients with measurement tools
to enhance patient compliance. Eddy VNA strongly believes
in the potential of the program to benefit payers, providers
and patients alike.
Click here for the complete article published in the July 2010
issue of Caring Magazine by the National Association for
Home Care and Hospice (NAHC).
care ad.indd 1
License #0564249
3/16/09 3:37 PM
CAHSAH’s NEW Group Purchasing Vendor
for Background Screening
The following Q&A is the beginning of a series of articles to acquaint you with SingleSource and
the services they provide and to provide background screening information and education.
How long have you been in business?
supplemental searches to a package if there
are special requirements.
SingleSource was established in 1995 and has
been in business continually since then and
now boasts over 2,300 established clients in all Do you provide training? Is software
installation required?
industries and geographies.
Our system is a web based program and so
no software downloads are needed. Our
Where are you located?
team walks every new
SingleSource is
client through set up,
headquartered in
ordering, and how
Jacksonville Beach, FL
to retrieve reports. A
from where all clients
dedicated account
are serviced. Our hours
representative can
of operation are from
answer any question as
8am PST to 5pm PST.
it relates to reporting.
Do you have existing
home care clients?
SingleSource has clients
nationwide in the
healthcare industry in
general and is especially
proud to call over
200 Visiting Angels
franchisees our clients.
These include a number in California who
have valued our quality and integrity for a
number of years.
99.9 percent of
database searches
are same day/next
day. County level
searches are promised
within three days but
marginally this is exceeded due to issues
beyond our control.
How can I best become familiar with your site
for my most efficient use?
Request a demonstration and allow us to
guide you through your specific question or
How long does it take to set up an account?
Usually same day
What is progressive screening and how can I
best use that to my advantage?
Normally our clients order a package for a
background screening inquiry. This method
allows for the process to be conducted search
by search and can be used to cut costs if early
inquiries produce information disqualifying
the candidate.
Will you provide guidance so that we are not
over-screening or under-screening?
Our packages were designed to provide the
best opportunity to ensure a suitable care
giver is hired. You will always be able to add
What about
turnaround times?
What about reports? Will we be able to
customize for our specific locations?
Our system provides many standard reports,
but each user has the ability to create and
download custom reports to meet their needs.
How do you ensure accuracy and current
We check our research with “salted requests”
– inquiries to which we know the answer. All
records found are reviewed before submission
to users. We monitor laws, and our system
flags state and federal legal issues such as
California’s laws relating to copies of reports.
Will CAHSAH have a key contact for every day
questions or will I be sent to a customer service
Each account has a dedicated account
representative from our team. We answer the
phones with people, not technology.
Contact Information:
Carl Tremble, Director of Business Development
800-713-3412, ext 111
“Heffernan Insurance Brokers
approached us to offer a
quotation for our renewal.
Since they are the CAHSAH
group purchasing vendor for
workers’ compensation and
have specialized in home care
for over 20 years, we gave
them a shot. We were more
than pleased. They saved
us over $14,000 and were
extremely easy to deal with.
We have been very pleased
with their customer service
and ongoing
efforts to help us
save money.”
Sharon Niederhaus
Competent Care, Costa Mesa
If you are not currently
participating in one or more of
CAHSAH’s group
purchasing programs,
you are missing out!
Take time to SAVE TIME and/or
DOLLAR$ -- now and later!
Contact CAHSAH group
purchasing vendors directly:
Heffernan Insurance Brokers
(800) 234-6787
Workers’ Compensation & Liability
(888) 538-4462
National Supply Chain
Philips Telehealth Solutions
(866) 554-4RPM
Telehealth Equipment
SingleSource Services
(800) 713-3412
Background Screening
Strategic HR Services
(800) 789-5655
Human Resources Services
A GPO Participant
‘Thou Shalt Give the First Referral’
hen I joined Accredited over 11 years ago, I was always encouraged to develop
relationships with my home care competitors. Accredited’s culture of working
with ‘friendly competitors’ comes from a belief that we can do more good for our
community and our industry by working together than by working against one another. When
I joined CAHSAH’s Board of Directors last year, I hoped to spread this philosophy amongst our
membership. Working with CAHSAH Staff and Committee Members, we developed RAMP
(Referrals and Admissions for Member Providers). Basically RAMP is a concept to promote
member-to-member referrals, much like a Chamber of Commerce would hope to accomplish.
The RAMP Concept definitely works. Last year, Accredited admitted 22 patients and generated $109,240 from CAHSAH
member referrals. Okay I won’t lie, the dollar figure is nice and is yet another incredible benefit of paying our CAHSAH dues,
but it is equally satisfying to know you’ve earned the trust and respect of other home care cohorts.
RAMP is a new CAHSAH program and we’d love to hear your success stories. We want to help you track and quantify
this CAHSAH added-value. First, review your Inquiry/Referral Call logs every month. Second, identify all referrals
from other home care agencies. Third, check the CAHSAH website to see if these agencies are CAHSAH members.
Fourth, every month calculate the revenue for these admissions. Fifth, share this information with CAHSAH.
This takes me about 30 minutes each month but it reinforces the value of being a member.
Of course, just joining CAHSAH isn’t a guarantee that referrals will come. Get involved. Meet your
CAHSAH colleagues locally or as part of CAHSAH-sponsored events. And remember one of the Ten
Commandments of Networking – ‘Thou Shalt Give the First Referral’.
Next year, we will report on the impact of RAMP for all members. Get involved now.
Neil Rotter, Vice President of Business Development
Accredited Home Health Services
Thanks to our members who have supported CAHSAH’s
recruiting and retention efforts, which include projects
such as phone calls, handwritten notes, task force
participation, conversation with peers, testimonials:
Gabriella Ambrosi, Sequoia Senior Solutions, Inc
Barry Berger, Accredited Home Health Services
Karrie Decker, Kaweah Delta Home Health Agency
Dave Dial, Pro-Care Home Health Services
Ken Erman, Rx Staffing and Home Care
Craig Falk, Craig Cares
Jason Grinstead, Care At Home
CAHSAH truly appreciates your commitment of time and
your passion for the home care industry!
At Your Home Familycare receives 2010 San Diego Award
for the second consecutive year. At Your Home Familycare
has been selected for the 2010 San Diego Award in the
Non-Medical Home Care Services category by the U.S.
Commerce Association (USCA).
The USCA “Best of Local Business” Award Program
recognizes outstanding local businesses throughout the
county, identifying companies they believe have achieved
exceptional marketing success in their local community
and business category. These are local companies that
enhance the positive image of small business through
service to their customers and community.
CAHSAH congratulates Laurie Edwards-Tate and her staff
for their fine industry and community representation!
CAHSAH Welcomes
New Members!
Please help us extend a warm welcome to those new
members who have recently joined CAHSAH between
August 17, 2010 and September 21, 2010.
Amdal In Home Care, Tulare, CA
Auspice Home Care, Fresno, CA
Helping Hands, Pacheco, CA
iCare Home Health Agency, LLC, Pinole, CA
NurseInstead Inc., Palo Alto, CA
Regency Senior Care, Los Alamitos, CA
Senior Assist of the Peninsula, LLC, Burlingame, CA
Ashken Chglyan, Sun Valley, CA
Lori Butler, Rancho Palos Verdes, CA
SingleSource Services, Jacksonville Beach, FL
Online Update Capability
Next week each member agency will receive the link,
ID and password, allowing our
members to manage their
organizational profile online
at their convenience – i.e.,
agency name, address,
phone number, e-mail,
services, accreditations,
key contacts, payment
accepted, etc. The online
Resource Guide is updated
monthly and will reflect any changes
It’s easy. You just have to follow the instructions on the input
screen. This will keep the online information and CAHSAH’s
database current and will eliminate the summer push in
preparation for the published copy.
Watch for your new ID and password, then Go online and take a look!
Are You Displaying
If you have a signed License Agreement with CAHSAH to use
the CAHSAH logo on your website, stationery, brochures or
as part of your promotional material, please be certain you
are using the CURRENT
logo. If you need an
updated CAHSAH Logo,
please contact Michele at
[email protected] or
(916) 641-5795, ext. 129.
If you would like to use
the CAHSAH logo but do
not have a signed License
Agreement on file, click here. Please review, sign and either fax
to (916) 641-5881 or email to Michele at [email protected]
A file of the logo will then be emailed to you.
CAHSAH’s YouTube Channel
Be sure to take a look! New videos are added on a regular basis
– CAHSAH events, late breaking news, member testimonials, to
name a few.
If you are interested in recording
a CAHSAH testimonial, contact
Ranesh at [email protected]
for more information.
click here
Extraordinary Executives
Produce Extraordinary Results
xecutive management is
an important investment
in the people who lead and
execute your organizational
strategies. It is also something that
often gets side-barred because
business executives are busy
and have numerous priorities.
However, well-trained executives
can enhance productivity, produce
better alignment between business
functions, improve retention of
talented employees, and build overall
morale in the agency. The results of Hospice and Home Care Executive Certificate Programs
will filter through your agency and provide bottom line results and produce operational
achievements. By attending these programs you will gain a sense of confidence and a practical
working knowledge that will create the alignment needed to achieve extraordinary results.
Dates and Location
Hospice Executive Certificate Program
November 2-4, 2010 - New York, NY
Program brought to you by:
CAHSAH with support of NAHC and
The Corridor Group
Home Care Executive Certificate Program
November 3-5, 2010 - New York, NY
Program sponsored by:
Care West Insurance Risk Management
and HospiScript
Click here for more information on these certificate programs,
or contact Richard Starks at: [email protected] or (916) 641-5795 ext. 117.
Is ADR on Your Radar?
Sponsored by: Kinnser Software
f ADR isn’t currently on your radar, it
should be! Many agencies have already
experienced ADRs and quickly learned
the effect of it. Home Health ADRs affect
sequential billing which means Medicare won’t
pay that claim until it is resolved. Taking a
risk by not educating yourself or staff may be
critical to your cash flow.
Sign up for this upcoming course that will
provide basic information on the Additional
Development Request (ADR) process. From
medical review to claim denials, and the appeal
process, our expert faculties, Annette Lee and
Sally Rosiello will supply you with helpful
suggestions for responding to ADRs in an
appropriate and timely manner.
Dates and Locations
December 6, 2010 - Sacramento, CA
December 7, 2010 - Ontario, CA
For more information or to sign up for this program,
please visit our website.
The Insider’s Guide
to Home Health Software
We all have many of the same questions
about home health software:
How do I get started? Who do I include in the decision?
What are people in my area using?
Attend this interactive one day workshop led
by consultants Carol Anderson and David Tapia,
to learn an effective process to both select the
right software for your agency’s point of care,
billing and administration needs as well as
implement it to maximize the value of your
investment. At the end of the workshop, stay
and listen to a panel discussion which features
representatives from various home health
agencies discuss the variety of vendors on the
market today. This workshop is recommended
for any agency owner or administrator who is
actively considering a software solution and/or
any individual considering starting or buying a
home health agency.
Dates and Locations
November 16, 2010 – Ontario, CA
November 17, 2010 – Sacramento, CA
Program sponsored by Kinnser Software
For more information please visit our website.
Don’t Leave Money on the Table
Sign Up for OASIS-C Training
Sponsored by: Kinnser Software
ften times, reimbursement issues tend to be overlooked
when clinical training occurs. Diagnosis coding can
also negatively impact reimbursement amounts if
clinicians aren’t careful. The best thing an agency
can do is give their clinicians the training they need to ensure
proper reimbursement. The upcoming OASIS workshop will
dedicate an entire session to the review of the NRS calculation,
reimbursement, orders requirements, as well as all “M” Items that
will impact reimbursement. Other sessions will include review of
administrative process changes, reporting of M0110, defining a
correction policy and review of each section of the OASIS-C with
specific instructions on completion of these items.
Workshop Dates and Locations:
November 2-3, 2010 – Sacramento, CA
November 4-5, 2010 – Ontario, CA
The COS-C Exam will be offered following the workshop.
Please visit for additional details.
Exam Dates and Locations:
November 3, 2010 – Sacramento, CA
November 5, 2010 – Ontario, CA
How to Produce Audit Proof
Care Workshop Wrap Up
Arnie Cisneros P.T., of Home Health Strategic Management
presented to over 150 attendees last month on “How to Produce
Audit Proof Care”. The program was very well received, with
high evaluation scores and rave reviews. Arnie addressed an
important topic for Home Health providers currently facing
audits and other refinements to the Medicare system which
included how to modify care practices to address changes
facing our industry. Audience members, consisting of owners,
administrators, managers, and clinicians currently working
in homecare, experienced a rousing session that included
information on progressive topics such as a History of Medicare
Reforms, S.U.R.C.H., A Utilization Review program for homecare
and OBQI Case Conference. A new twist on an old model,
strategies for the 2011 PPS Proposed Rule, and crowd-pleasing
interactive exercises to help integrate the changes in philosophy
required by the latest reforms. Whether you missed this program
or want to educate your staff on the topic, this program is now
available on audio CD.
Members: $168.56 Non-Members: $331.69
For more information on ordering an audio CD of this workshop, please
contact Kairsee Tacher at (916) 641-5795 ext. 113
Attendees comments included:
“Excellent course.” “Great presentation.”
“I wish I had my staff present so they could get it.”
Hospice and Home Care WRAP UP
Administrator Program
he Hospice Administrator Certificate Program and
the Home Care Administrator Certificate Program
were once again resounding successes in Las Vegas.
With over 150 people attending the sessions, it was
a fast-paced and information-filled three day program.
Some participants were graduates of the HMCP and HCMCP,
and others were experienced hospice and home health
professionals looking for more education. But everyone
enjoyed the interactive discussions, the excellent faculty and
the Las Vegas venue.
The speakers in each program brought years of experience
in the industry and leading edge, fresh information so the
participants could strengthen their skill as administrators
and help guide their programs to success in the changing
regulatory and reimbursement environment.
Jeannee Parker Martin, RN, MPH, President of The
Corridor Group framed up each program with her
updated presentation on trends in the industry and
strategic positioning for success.
Christine Lang, Senior Director of Product Strategy
for OCS provided insights into quality performance
management and understanding the direct application
of good measures and data analysis on successful
hospice and home health providers.
Christie Whitney, President and CEO of Hospice &
Palliative Care of Western Colorado, “wowed” the HACP
attendees with her understanding of the hospice
industry and also the application of strategic positioning
fundamentals to successful growth.
Teresa Craig, CPA, CEO of Suncoast Solutions, provided
an excellent framework for understanding hospice
Ken McNulty, CFO at VNA of Boston and Lynda Laff,
Associate of The Corridor Group, brought home the
financial and clinical realities of managing a home
health agency.
Deborah Randall, Esq., of the Law Office of Deborah
Randall, provided a mini-law course on how your
organization must be rigorous in all aspects of
compliance to assure you don’t find you or your
organization facing unnecessary penalties.
If you qualify for the Hospice or Home Care Executive
Program, we are presenting an incredible program in New
York from November 2 -5 with an exciting faculty: Bill Dombi
from NAHC, Kathy Dodd from The Corridor Group, Pat Laff of
Laff Associates and Lynda Laff of The Corridor Group, Chris
Attaya of Partners Home Care and Hospice. The exciting
format is a case study format, so don’t miss out!
For a list of graduates of these two programs, please visit the CAHSAH website
For more information on the Executive Programs and 2011 Manager and
Administrator Programs, go to
events/Cert_Programs.asp for dates and locations.
Home Care Providers
Indicted for Referrals Kickbacks
Elizabeth E. Hogue, Esq.
n December 18, 2008 a federal
grand jury indicted owners and
employees of eight home health
agencies in the Metro-Detroit
area on charges that they took part in a plan
to solicit and pay kickbacks in exchange
for Medicare patient referrals. This plan
was devised by Rebecca Sharp, president
of Continuing Senior Care, Inc. in Ypsilanti,
Michigan, who allegedly received over $1.1
million in kickbacks.
According to the
indictment, Sharp
obtained potential
home health patients
by directing her staff
to randomly telephone
senior citizens in order
to offer them medical
services and chore
workers. If any senior
citizen was curious as to
how Continuing Senior
Care received his or her contact information,
employees were instructed to state that this
information came from Medicare. When a
senior citizen agreed to the offer, employees
would acquire patients’ Medicare information.
Patients would then be visited by a doctor,
employed by Sharp, who measured vital
signs and prescribed home health care to
all patients, whether or not it was medically
gives anything to anyone in order to induce
referrals has engaged in illegal conduct. In
this case, the payments allegedly made by
home health agencies to Continuing Senior
Care seem to have been made in exchange for
referrals in direct violation of the anti-kickback
In addition, it is important for providers
to note that if the referrals were obtained
illegally in violation of the anti-kickback
statute and agencies submitted claims for
services provided to patients referred by
Continuing Senior Care,
such claims may also violate
the federal False Claims Act.
The Office of the Inspector
General (OIG) of the U.S.
Department of Health and
Human Services, the primary
enforcer of fraud and abuse
prohibitions, has clearly
stated that claims submitted
for services provided to
patients who were referred
in violation of applicable
prohibitions are “false claims.” Submission
of false claims may also result in criminal
prosecution and/or civil liability, amounting to
many thousands of dollars and suspension or
exclusion from participation in the Medicare
and Medicaid Programs and other federal and
state healthcare programs.
In addition to the necessity to avoid payment
of kickbacks, therefore, providers must be
scrupulous about avoiding all illegal strategies
for obtaining referrals. When referrals
are obtained by any unlawful means, the
consequences can be extremely significant for
Following this, Sharp referred the Medicare
patients to home health care agencies. She
allegedly offered to refer eighty patients and
Medicare numbers each week in exchange
for a $250 fee per patient. In addition, Sharp
claimed that the doctors whom she employed Consequently, as part of the development
would sign plans of care regardless of patients’ of new marketing strategies, management
actual medical needs.
must always explore the legal boundaries
of proposed methods of marketing prior to
With regard to the ramifications of this case,
implementation. In order to do so, marketing
U.S. Attorney Terrence Berg stated that “when staff cannot be allowed to implement new
Medicare is abused by unscrupulous persons marketing programs without review and
to pay for unnecessary treatment and to
approval by management. Review must
garner kickbacks, that conduct harms both
include a thorough examination of whether
legitimate Medicare recipients as well as the
the marketing program, as proposed, violates
program itself.”
applicable prohibitions and, if so, whether it
can be changed so that it passes muster.
There is a federal law that prohibits illegal
©Copyright, 2010.
remuneration. This law is often called the
Elizabeth E. Hogue, Esq. All rights reserved. No portion
anti-kickback statute. It generally says that
of this material may be reproduced by any means
anyone who either offers to give or actually
without the advance written permission of the author.
CAHSAH State Bill Tracking
Bill Number
General Business
AB 1735
AB 2334
Priority A Legislation
Position Location
Created a tax credit equal to 50 percent of the amount of costs paid or incurred in connection with
additional career advancement or retention education and training.
Prohibits a medical provider, or health facility from charging, assessing, or collecting, directly or
Oppose through a collection agency, or pursuant to any judgment, any interest on, or late fees or charges out
of, any unpaid bill for medical services rendered.
Health Care Practices
SB 971
Would impose specified requirements on providers of blood clotting products for home use used for
the treatment and prevention of symptoms associated with bleeding disorders.
AB 950
Would allow in-patient beds as part of a hospice’s current license and not require the hospice to have
a separate facility license.
AB 2523
Relaxes the congregate living health facility (CLHF) population requirement to allow for a CLHF in a
population with 400,000 persons.
Health Care Coverage
AB 2586
Would require a plan or an insurer that contracts with providers to obtain approval from its regulating
dept. prior to implementing a health network modification.
AB 179
CAHSAH sponsored bill to remove the weekly pay requirement. Would permit employees of
temporary services employers of health care services to be paid semimonthly.
AB 482
Prohibits an employer from obtaining a consumer credit report for employment purposes unless the
information is substantially job-related.
AB 1603
Would require that an employee be deemed to be temporarily partially disabled during the period
when the employee’s disability is permanent and stationary, no more than 60 days have elapsed
after the date the employee was informed that his or her disability is permanent and stationary, the
employer has not offered the employee regular, modified, or alternative work, and the employer has
not informed the employee that it will not offer the employee regular, modified, or alternative work.
AB 1994
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.
AB 2187
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.
SB 182
Would delete the limitation that temporary clinical nursing faculty be employed for not more than 4
semesters or 6 quarters.
State Funded Programs
AB 1260
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.
AB 1506
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.
AB 1864
Would provide that Medi-Cal providers be paid even when the state has not passed a budget for the
(Strickland, Audra) current fiscal year.
SB 886
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.
Died in Revenue and
Taxation Committee
Gutted and Amended to
no longer impact home
To the Governor’s Desk
Died in Appropriations
Died in Senate
Support Died in Appropriations
Support Died in Labor & Industrial
Relations Committee
Oppose Vetoed by the Governor
Oppose Died in Insurance
Oppose Died in Appropriations
Oppose Vetoed by the Governor
Failed passage in Higher
Education Committee
Support Gutted and Amended to
become another bill Support To the Governor’s Desk Support Gutted and Amended to
become another bill
Support Died in Senate
Wage & Hour and Labor Laws... All Available in the CAHSAH Bookstore!
Labor Law for the Non-Union Agency by John Gilliland, Gilliland & Markette LLP
Is your agency taking the necessary steps to remain “union free”? This guide helps explains the mechanics
of union organizing and gives a realistic step by step approach on how to avoid becoming a target.
Members: $107.66
Non-Members: $216.41
California Wage & Hour Law for Home Care Aide Organizations An Overview
An overview to wage and hour law in California that may apply to your organization including wage orders,
minimum wages, meal & rest periods, requirements for time sheets, maximum hours and days of work, violations,
and enforcement. Designed to expose agencies to common wage and hour issues as well as how to comply with the
requirements of California wage and hour law.
*All prices include shipping, handling & tax.
Members: $168.56 Non-Members: $331.69
Call (916) 641-5795 ext. 113 or visit to order these essential resources!
Federal Bill List
Bill Number
S 795
Health Care Coverage
H.R. 3590
S. 3315
Position Location
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
Senate version of health care reform, referred to as the Patient Protection and Affordable Care Act Watch
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.
Health Care Workforce
H.R.468 (Schakowsky) Expands training and support to all sectors of the health care workforce to care for the growing
S.245 (Kohl)
population of older individuals in the United States.
S 631
S 1788
HR 2381(Conyers)
Home Health
HR 5803 (McGovern)
S. 3315 (Collins)
HR 4993 (Schwartz)
S. 2814 (Collins)
HR 1094
S. 1157
H.R. 3030
Referred to Finance
Signed by the President
Referred to Finance
Referred to House
Education and Labor
Referred to Senate
Finance Committee
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.
Requires the use of engineering controls to perform all lifting, transferring, and repositioning of
Oppose Referred to
patients and eliminates manual lifting of patients except where the use of safe patient handling
Subcommittee on Health,
practices can be demonstrated to compromise patient care.
Employment, Labor and
Preserves access to home health services by establishing a more transparent process for evaluating
case mix changes.
Allows Nurse Practitioners, Advanced Practice Nurses, and Physician Assistants to
sign Medicare home health care plans. 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.
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.
Sets up pilot projects through the Dept. 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
& Commerce Committee
Support Newly Introduced
Referred to House Energy
& Commerce Committee
Support Referred to Senate
Finance Committee
Support Referred to House
Energy and Commerce
Home Infusion
HR 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
Imposes a temporary moratorium on the phase out of the Medicare hospice budget neutrality
adjustment factor.
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
Information Technology/Telemedicine
HR 2068
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.
Amends title XVIII of the Social Security Act establishing additional provisions to combat waste,
fraud, and abuse within the Medicare Program.
H.R.902 (Smith, A.)
S.712 (Feingold)
(Davis, D.)
Amends title XVIII of the Social Security Act to improve the provision of items and services provided Watch
to Medicare beneficiaries residing in rural areas.
Amends title XIX of the Social Security Act to provide individuals with disabilities and older
Americans with equal access to community-based attendant services and supports.
HR 1409
S. 560(Kennedy)
Amends the National Labor Relations Act to establish a check card system to enable employees
to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor
practices during organizing efforts.
Referred to Senate
Finance Committee
Referred to Senate
Finance Committee
Referred to House
Committee on Energy
and Commerce, and
Committee on Ways and
Referred to House
Referred to House Energy
& Commerce Committee
Referred to House Energy
& Commerce Committee
Oppose Referred to
Subcommittee on Health,
Employment, Labor and
Better Outcomes Through
Standardized Patient Care
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