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HCBS Program Orientation / Training Program Handbook

“DOING ORDINARY THINGS...EXTRAORDINARILY WELL”

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TRAINING AND ORIENTATION HANDBOOK HCBS New Employee Program Training Initial Orientation Training - All new staff will receive a training in packet form or computer based (RELIAS) which will be signed off on using an Acknowledgement of Training Requirement For HCBS Homemaker Department Orientation Form. This initial training will consist of: a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. s. t. u.

Agency Mission/Vision Mileage Reimbursement / Geographic Location EVV System Policy / Procedure/Attestation Homemaker Point System Dress Code Employee Conduct / Annual Health Assessment Documentation of Services / Client Changes Reporting Form Handling Consumer Funds Emergency Contacts Confidentiality HIPAA/HITECH: A Primer Emergency Preparedness HCBS Settings Rules HCBS: Who We Serve CHOICES, VA, HOPWA, SSBG / PCSP / CLS Consumer Safety/ Rights / Consumer Grievance Title VI Civil Rights Policy / Non-Discrimination In Services Daily Sheets / Weekly Reports / Missed Visits Critical Incidents / Accidents / Reporting / Management Communication Resources Whistleblower Act Critical Incident Reporting CHOICES: Test

II. Relias Training - To access the Relias Learning Training on a Monthly basis, staff will need to sign into the Relias website at http://meritan.training.reliaslearning.com once on the site: a. Click on the MY Learning Tab at the very top b. This will take you to a screen that says Browse Elective Courses (in green). Click on the green button that says, “Browse Elective Courses” c. This will take you to a screen with three boxes across the top. Click the “Filter By” box (arrow) that says “All Owners” and select “Meritan Memphis”. The next courses will open. Click enroll to begin the course d. Once the course is completed repeat the process to enroll in the next course. HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 9


TRAINING AND ORIENTATION HANDBOOK e. Print to a pdf all certificates and email a copy of the certificate to Program Director AND Administrative Coordinator. III. Quarterly Inservice Trainings will have a sign-in sheet with date/time of arrival for each quarterly training.

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TRAINING AND ORIENTATION HANDBOOK ACKNOWLEDGEMENT OF INITIAL/ORIENTATION TRAINING REQUIREMENT FOR HCBS ⬜ ADMIN /CASE MANAGEMENT STAFF ⬜ HOMEMAKER STAFF ⬜CLS CHOICES STAFF I, _______________________________________________________________, hereby acknowledge that I received orientation training on the following topics listed below, all of which are required prior to me providing care to all members supported through HCBS programs in the following areas: SSBG, VA, CHOICES and HOPWA programs. I also have had the opportunity to ask questions and clarification on the topics discussed. Classroom

RELIAS

⬜ Agency Mission/Vision/Policies ⬜ Mileage Reimbursement / Geographic Locations ⬜ Santrax / EVV System ⬜ Homemaker Point System ⬜ Dress code ⬜ Employee Conduct / Annual Health Assessment ⬜ Documentation of Services / Client Changes Reporting Form ⬜ Handling Consumer Funds ⬜ Emergency Contacts ⬜ Confidentiality HIPAA/HITECH: A Primer ⬜ Emergency Preparedness ⬜ HCBS Setting Rules Policy ⬜ Who We Serve (SSBG/VA/HOPWA/CHOICES) ⬜ Consumer Safety/Rights / Consumer Grievance ⬜ Title VI Civil Rights / NonDiscrimination Policy ⬜ Communication Resources ⬜ Whistleblower Act /DRA ⬜ Critical Incident Reporting Process ⬜ TEST: Orientation to the Population __________________________________________________ Employee Signature

⬜ Homemaker Do’s and Don’t ⬜ OSHA Compliance Essentials ⬜ Personal/ Hand Hygiene Basics ⬜ Infection Control ⬜ Fraud/Elder Abuse/Neglect ⬜ BloodBorne Pathogens ⬜ Handling Aggressive Behaviors ⬜ Cultural Competence ⬜ Ethical Behavior ⬜ Homemaker Standards - In-Home Care - Housekeeping - Meal Preparation - Errands & Grocery Shopping - Medication Management - The Elder/Disability Population - Person Centered Planning ⬜ Disability Awareness & Aging

_____________________ Date

*By signing this I understand that at any time I do not understand policy or procedure I am asked to follow or perform, it is my responsibility to ask my supervisor for clarification.

_________________________________________________ Trainer (Admin. Coord. / Designee)

______________________ Date

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IN-SERVICE TRAINING All new employees will receive a minimum of a 40-hour orientation in classroom, online and preceptor shadowing training, to help you understand our Homemaker (SSBG, VA, HOPWA, Private Pay) and CHOICES / CLS Programs. The orientation will include an overview of all policies and procedures for the Homemaker Division as well as training specific to the role you will have. You will then be assigned to a preceptor to receive on the job training.

You will assist him/her with his/her assignments.

Competency will be evaluated on an annual basis with monthly and quarterly training. Before receiving your first assignment, you will meet with the Supervisor and/or Designee to discuss any needs, concerns, or problems. During your employment with Meritan, you will be participating in agency meetings on patient care and in-service training sessions. You will receive credit for your participation and shall be paid for attending on-site training. Online training is your responsibility and can be completed on your own time on any device such as a personal computer (desktop or laptop), IPad or IPhone. A minimum of twenty-five hours of training is provided per year. Your performance goals and objectives for your 90 day, six month and annual evaluation will be based upon training and in-service goals and objectives.

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AGENCY MISSION/VISION/HCBS

Mission Statement Improve well-being and promote independence throughout life's stages with quality and compassion.

Vision To fill in service gaps and meet unmet needs To provide services that benefit humanity and improve the community To be financially secure To be a good place for people to work To be a place that clients and referral sources seek out To be a leader in our industry To be passionate about quality

HCBS - HOMEMAKER SERVICES In Home and Community Based Homemaker Services, “we do ordinary things extraordinarily well.” At our heart there’s this culture around continuous improvement and also around a passion for the values of human service. At the heart of the Meritan Home and Community Based Services Homemaker journey there are incredibly passionate people … and they come to work each and every day wanting to do a great job serving individuals and families.

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Mileage Reimbursement Forms must be legible and completed in ink. All forms must have the following information: 1. Program name, position, month and year, and employee signature 2. Complete names and address of places traveled from and to 3. Beginning and ending odometer readings 4. Correct mileage totals 5. Parking amount (if applicable), provide receipt 6. Amount of telephone calls (if applicable) 7. Purpose (i.e. clients home to Walgreen’s; Walgreen’s to Easyway; return to client; office to turn in paperwork) The person(s) designated to check the forms will have a list with the employee’s name and will check off the employee’s name when the form has been received for the month. The employees who have not submitted forms for the month will be contacted by the supervisor to determine the reason for the delay in submitting the forms.

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Preferred Geographic Locations MEMPHIS / SHELBY COUNTY Preferred Geographic Location Form ***While we cannot guarantee you that you will always work in your preferred geographic location we will try our best to accommodate your preferences.*** Name ___________________________________________________________ Address _________________________________________________________ Cell / Phone Number (___ ___ ___) ____ ____ ____ - ____ ____ ____ ____ Locations (Choose Your Top Three Preferred Locations)

☐ Frayser/Raleigh ☐ Whitehaven/Westwood ☐ North Memphis ☐ South Memphis ☐ Midtown/Downtown ☐ Bartlett ☐ Cordova ☐ Hickory Hill/East Memphis ☐ Millington/Arlington ☐ Collierville ☐ Germantown ☐ Binghampton ☐ Oakland / Lakeland ***Is there any area you would prefer NOT to work in? ________________________________

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The EVV (Electronic Visit Verification) System Policy Policy The EVV system is an electronic system that paid caregivers use to check-in at the beginning and check out at the end of each period of service delivery. The system is used to monitor member receipt of specified HCBS services and to generate claims for submission. The EVV system is monitored for billing, exception handling, scheduling, employees checking in and out, and late or missed visits on a daily basis. One full-time employee (HCBS Scheduler position) monitors the system; while two designated employees (HCBS Program Director and Administrative Coordinator) are knowledgeable of the system and are available to assist when necessary. Reporting to CHOICES (Amerigroup, BlueCare, United Health) is required ASAP for any deviations from the members plan of care. A deviation maybe the member refused services, inclement weather, missed/late visits, etc. Meritan’s HCBS Department maintains an employee on-call for after hours and weekend scheduling issues. The system is monitored for late or missed visits. Phone calls are routed through the answering service or directly to the on-call employee’s cell phone. All calls are handled immediately. If the on-call employee does not respond to the answering service, the Program Director is notified. Meritan’s HCBS department maintains a staffing plan for all CHOICES members in the event the regular worker is not available. This plan list both a primary and secondary backup staff person to provide services in the event the primary Home Care Specialist is unavailable. The member is notified of any staff changes in advance. Staff contact information is updated as needed in the EVV system and Sandata will be notified upon updates. Services to Members Before a member can receive services, TennCare eligibility is verified through the TennCare verification system. Verification documentation is printed and maintained in the member’s HCBS file. All visits are scheduled in the EVV system at least one week in advance. All exceptions are worked within 24 business hours. When a members cancels a visit, the MCO is notified HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 16


The EVV (Electronic Visit Verification) System Policy immediately by email or phone and proper notations are completed in the EVV system. All member status changes are noted in the EVV system and reported to the MCO. After services are rendered, claims are submitted through the EVV system. Claims are submitted within 120 days of service. Training For those employees that will be utilizing the Santrax system, Meritan documents initial training of employees to the EVV System. An orientation checklist documents the training and is placed in each employees file. The employee is trained on how to call in and out of the EVV system and how t enter the tasks performed. The employee will complete the survey at the end of the visit. Additional training is provided as updates occur. Employees not utilizing the EVV system properly will receive additional training. Disciplinary action will be taken if the occurrences continue. For those who will be monitoring the EVV system, initial training is conducted and an acknowledgement is signed and placed in each employee’s file. Additional training is provided as updates occur.

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The EVV (Electronic Visit Verification) System Training Learning Objectives: Supporting CHOICES Members (Use in Conjunction with EVV Training Handout)

At the end of this training you should:

❖ Have a clear understanding of what the EVV system is and is used for. ❖ Know how to clock in and out when supporting a member (client). ❖ Know where to find and how to utilize additional training resources.

What is EVV? EVV is the Electronic Visit Verification System and monitors member receipt and utilization of CHOICES Homemaker HCBS. The EVV System is an electronic system Provider staff and consumer-directed workers use to record visits with members. Users check-in and out at the beginning and end of each service delivered to monitor member receipt of HCBS. EVV also used for submission of claims. The system acts as verification that services are being performed within the member’s preferred schedule, approved location and may also be utilized by the provider for submission of claims (insurance). Only certain services are documented through the EVV system. Those services include: HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 18


❖ Personal Assistance ❖ Supportive Home Care ❖ Respite Care (Respite will require manual entry)

EVV Compliance Failure for Meritan, Inc as a Provider to comply with expectations on the appropriate utilization of EVV can result in disciplinary actions up to potential termination from the CHOICES network.

The EVV Tablet When providing services to CHOICES (CHOICES is the name of the State insurance program. CHOICES members will have either Blue Cross/Blue Shield - known as BlueCare or Amerigroup Health Insurance) eligible clients, you will find a tablet in the home of each member/client. Use this tablet to clock in and out at the beginning and end of your shift.

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The EVV (Electronic Visit Verification) System Training If there are technical issues with the tablet, please contact the MCO at the number on the back of the tablet. A representative will work with you to fix the tablet.

Checking In and Out on the Tablet Checking In: There are three options for caregivers to check in and out at a member’s location: ➢ Tablet, also referred to as a static device ➢ Smartphone app, this can be accessed from your own phone ➢ Telephone The two preferred methods are via tablet and phone app. These methods should be utilized every time unless there is a technical issue with the tablet or your smartphone app. The telephone should be the last option. If the telephone must be used you will need to know the phone number to call, the agency ID, your worker ID and the appointment number you are clocking into.

Logging Onto the Tablet Prior to arriving at a member’s home for the first time you must set up your profile from the app or a computer. You will need your company ID, username, password, and you will select a security image. All of these items will be used when clocking in and out during the visit.

Checking In The check in/out must occur within a certain radius of the client/member’s address. Checking in should not occur on the way to the client/member’s home/residence, it should only occur once you have arrived.

Checking Out When checking out from the clients/member’s home, you must use the same method you used to clock in. You will need to enter tasks performed during the visit, answer questions related to the member, enter any visit notes and sign for the check out. Additionally there is a provider survey that must be completed by you prior to leaving.

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The EVV (Electronic Visit Verification) System Training If you forget to check in or out If you forget to check in let the Scheduler or your Program Director know as quickly as possible. The MCO - CHOICES will be contacting the Provider (Meritan) if the Home Care Specialist has not checked in within 15 minutes of the scheduled arrival time or for late arrivals (missed/late visits).

QUESTIONS????

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The EVV (Electronic Visit Verification) System Electronic Visit Verification (EVV) Training Attestation I, _________________________________, have completed the EVV system training, and understand that the Sandata Technologies User Manual is available in the Homemaker Department for additional information. I also understand that if I require further training I need to let both my Program Director and Scheduler know. I, _______________________________________, further understand the requirements for setting up my profile in the EVV system using the Tablet, how to check in/out of the EVV system using the Tablet. I, ___________________________________, also understand that I cannot clock in prior to arriving at a client’s/members residence/home and understand that to do so is considered fraud. ___________________________________________ Staff Signature

____________ Date

___________________________________________ Trainer/Instructor Signature

____________ Date

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Staffing Plan / Availability Clients of the agency’s services depend upon receiving them regardless of weather conditions. For that reason, our offices will be open and staff on duty unless the Department of Human Services office located in the county of an employee’s workstation is closed. In the event of a sudden major disaster, Meritan will make every reasonable effort to continue to provide service. Employees will continue with their normal duties to the extent possible. Employees will avoid leaving any client in immediate peril. Meritan assures a workforce of HCBS in-home care staff with appropriate experience and training are available to provide services 24 hours a day, 7 days a week. Management and case managers are on-call 24 hours per day. Office hours are 8:15 - 4:30 pm Monday through Friday. All voicemail message instruct caller to push “0” to reach the emergency number In the event of a sudden major disaster, Meritan will make every reasonable effort to continue to provide service. Employees will continue with their normal duties to the extent possible. Employees will avoid leaving any client in immediate peril. Employees of Meritan are expected to provide services to any client upon request. For after hours and weekend staffing, Meritan employs a telephone answering service. The answering service shall contact the “on call” staff person within five minutes after receiving a telephone call from the client. In the event the on-call staff person fails to answer within 15 minutes, the Program Director will be notified. In the event the Program Director fails to respond the AVP will be notified. Staff will not make any changes to the schedule unless authorized by the scheduler or the supervisor. If you arrive at the client’s home and the client is not there for any reason or if the client is in the hospital, they will immediately call into the office to report this information. If the client requests you to leave, you must first call the office. Any time staff is unable to carry out their scheduled assignment (e.g. sickness, death in family, car trouble, etc.) they are responsible for notifying the agency. Failure to do so may result in immediate termination. Staff will not give clients their home or cell phone number. The client’s support coordinator or case manager and caregiver (as applicable) will be notified, with as much advance notice as possible, any time that a provider anticipates that HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 23


Staffing Plan / Availability expected/scheduled direct support staff services, such as personal assistance, may not be available. 1. Each homemaker client is assigned a primary homemaker. 2. An alternate homemaker receives training and orientation on each client. A staffing plan is included in each clients file. 3. If designated and/or alternate homemaker is not available, a substitute homemaker is dispatched to a client’s home. The designee is provided with instructions for care by the Scheduler and/or is provided a copy of the service authorization which details the type of care to be provided. 4. A new staffing plan is required annually. Scheduler/Case Manager are to complete staffing plans.

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Staffing Plan / Availability

Date of Staffing Plan:

________________________

Client Name:_________________________________________________________________ The Client will receive services from the following staff member: Primary Staff: ________________________________________________________________ Primary Staff Contact # _____________________________________________ First Day of Service: _______________________________________________ If the primary staff person is not available, we will implement a back up staffing plan. The back up staff person is: Back up staff:________________________________________________________ Back up Staff Contact # _______________________________________________

______________________________________________________________________ Case Manager Signature

______________________________________________________________________ Scheduler Signature

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HCBS PERSONNEL POINTS SYSTEM To maintain high levels of productivity and quality care, regular attendance and punctuality is a must. While we understand things happen, it is imperative you maintain communication with the office. Attendance - Late Visits Employees who do not come to work as scheduled have a negative impact on the organization and other staff members’ ability to provide quality service. Every employee has a responsibility to be on the job at the prescribed time every day they are scheduled for work. If you are not available to work, you must notify the office a minimum of two (2) hours prior to scheduled time unless emergency conditions make this impossible. Please note our funders have absolute zero tolerance for late/missed visits and will penalize the agency for this practice.

We

will no longer be able to manually confirm your visits. You will receive 1 point if you DO NOT contact the office at least two (2) hours before your assignment. You will also receive a verbal warning. This time frame allows us to notify the client and funder. Absent a documented emergency, if you DO NOT call the office or report for your assignment, you WILL be terminated. Missed Visits Employees are expected to report to work as scheduled. Missed visits will be assessed daily. A missed visit without notification is an automatic termination. If an emergency arises contact your supervisor/scheduler as soon as possible. Disciplinary Action Employees will be subject to disciplinary action when the total points accumulated reaches the following levels during any one year period. After 3 points, you will receive a verbal warning. After 5 points, you will receive a written reprimand. After 8 points, you will be terminated. ________________________________________________________ Staff Signature HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 26

__________________ Date


DRESS CODE Meritan regards all staff as representatives of the agency. Employees are expected to dress according to the requirements of their position and to present a neat and professional appearance at all times. However, we do want our employees to be comfortable. Some positions may require uniforms and the guidelines may vary slightly. There also may be occasions when more formal business attire is required (e.g. meetings away from the office, meeting customers, funders, etc.) and employees, particularly managers, are expected to dress in a manner that reflects a positive business image. ● ● ●

● ●

ID badges must be worn at all times while on duty. Loud perfumes are not acceptable. Employees may not wear - shorts - spandex or exercise clothing - Capri pants unless part of a uniform - Jeans - Sweat suits - Sweatshirts/sweat pants, leggings, stirrup pants - Tee shirts with messages or advertisements unless it is a Meritan’ tee shirt - Jogging pants - Athletic shoes (except in the delivery of patient or client care) - Rubber flip flops - Worn, tattered, cut off or ripped clothing - Clothing with messages or pictures that could be offensive to others - Distracting styles such as nose rings, eyebrow piercing, multiple piercing, visible tattoos, multicolored hair, etc - House shoes or bedroom slippers - Hair rollers - Revealing clothing such as too short skirts/dresses (no more than 3 inches above the knee), halter-tops, crop tops, backless tops and dresses, spaghetti straps, etc - Fingernails that are excessively long (more than 1 inch from the cuticle) - Tank tops or immodestly opened or plunging shirts - Tight fitting slacks or pants - Hats or caps indoors unless the temperature in your work space is uncomfortably cold for you - Bandanas on the head Glittery cocktail wear is not appropriate for work Appropriate dress includes, but not limited, to clothing which covers and does not allow exposure of one’s undergarments. Employees who deliver patient or client care may have further requirements imposed by their departments. For example, open-toed shoes may not be worn for safety reasons.

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EMPLOYEE CONDUCT Employees are expected to conduct themselves in an appropriate manner and to follow policies and procedures as well as professional standards at all times. Violation of work rules or professional standards will result in application of the disciplinary process described in this Manual. More offenses that are egregious can result in immediate dismissal of the employee without use of the disciplinary process. Conduct that is considered inappropriate includes the following: (The list is not intended to be all-inclusive.) ●

Falsification of records, reports, or other documents including personnel records, timesheets and client records, and willful misrepresentation of facts.

Gross negligence, gross carelessness or willful acts that result, or could result, in damage to agency property or equipment, or injury to other employees or clients

Insubordination and/or intentional refusal to perform assigned duties

Stealing, embezzlement, abuse, or endangerment of donors, employees, or property

Revealing confidential information to an unauthorized person

Intoxication or being under the influence of alcohol, drugs, mind-altering agents or possession of such while on duty (this includes abuse of prescription drugs.)

Abandonment of duty, such as being absent without authorization

Carrying weapons while working or on to agency property and violence of any kind, (Threats are assumed to have been made with the intention to carry them out.)

Use of obscene or abusive language

Harassing or interfering with the work of other employees or sabotage.

Distributing materials or soliciting during active work hours or on the worksite.

Unauthorized use of agency property, abusing, or defacing agency property

Secondary employment or external activities, which interfere with job performance or cause embarrassment to the agency

Excessive tardiness or absenteeism or unauthorized extension of meal and rest periods or leaving work early

Refusal to work with others as an effective team member

Refusal to work required overtime.

Engaging in malicious gossip or behavior designed to create discord or disharmony.

Loafing or sleeping on the job.

Performing personal business, receiving excessive personal phone calls during work time, or using work facilities without permission.

Accepting gifts, tips or favors which might influence the provision of services or performance of duties.

Violation of safety rules and failure to report immediately accidents or injuries

Violation of any local, state, or federal ordinance, law, or regulation while at work which could endanger others or have a negative effect on the agency

Actions or omissions that expose the agency to unnecessary risk or liability HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 28


EMPLOYEE CONDUCT DISCIPLINARY PROCESS FOR NON-MANAGEMENT EMPLOYEES Employees who do not meet applicable standards for performance are subject to discipline, which may include termination. In addition, there are performance and/or behaviors, which are so inappropriate that they may lead to immediate dismissal. Inappropriate conduct or behavior will result in action taken which is appropriate given the nature of the offense, mitigating circumstances, if any, and the employee’s previous work history. Discipline for non-management employees may include any of the following: ●

Oral reprimand (documented and kept in the supervisor’s file)

Written reprimand (placed in the employee’s personnel file) Suspension without pay (number of days may vary)

Discharge

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ANNUAL HEALTH ASSESSMENT Name: ________________________________________________Date: _______________ Position: ☐ VP ☐ Director ☐ RN ☐ CM/SW ☐ CNA ☐ HCS ☐ RCA ☐ Other 1. During the past 12 months, have you had any accident or illness that might interfere with your ability to perform your duties? ☐ No ☐ Yes If yes, please describe 2. During the past 12 months, have you had any accident or serious illness which required hospitalization or medical care? ☐ No ☐ Yes If yes, please describe 3. Have you had any illnesses from the notifiable disease list during the past year? ☐ No ☐ Yes If yes, please describe 4. Have you had any of the following symptoms in the past 12 months? ☐ No ☐ Yes Persistent productive cough lasting more than three weeks ☐ No ☐ Yes Night sweats/fever/chills ☐ No ☐ Yes Bloody sputum ☐ No ☐ Yes Chest pain 5. Have you received and/or completed the Hepatitis B vaccination series? ☐ No ☐ Yes If yes, did you receive the series while employed at Meritan? ☐ No ☐ Yes 6. Do you wish to receive the Hepatitis B vaccination at this time? ☐ No If yes, you must begin the vaccination series within one month.

☐ Yes

7. Do you have any condition that would cause breathing discomfort or anxiety when wearing a respirator mask? ☐ No ☐ Yes If yes, please describe: 8. TB Testing History Have you ever had a positive reaction to a TB skin test (PPD test)? If yes, when? If yes, did you receive a chest x-ray? ☐ No ☐ Yes

☐ No

☐ Yes

* A copy of an up to date Hepatitis series or declination, TB skin test (PPD), or chest x-ray is retained in the employee’s medical personnel file. HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 30


Notifiable Diseases Category 1 Anthrax Botulism 1. Food borne 2. Wound Diphtheria Disease Outbreaks 1. Food borne 2. Waterborne 3. All other Encephalitis, Arboviral 1. California/LaCrosse serogroup 2. Eastern Equine 3. St. Louis 4. Western Equine Group A Strep Invasive Disease Group B Strep Invasive Disease Haemophilus influenzae Invasive Disease Hantavirus Disease Hepatitis – Type A acute Listeriosis Measles

Meningococcal Disease Meningitis – Other Bacterial Mumps Pertussis Plague Poliomyelitis Prion Disease 1. Creutzfeldt-Jakob Disease 2. variant Creutzfeldt-Jakob Disease Rabies – Human Rubella and Congenital Rubella Syndrome Severe Acute Respiratory Syndrome (SARS) Staph aureus Vancomycin nonsen-all forms Tuberculosis – all forms Typhoid Fever West Nile Infections 1. West Nile Encephalitis 2. West Nile Fever (126)

Possible Bioterrorism Indicators Anthrax Plague Venezuelan Equine Encephalitis Smallpox Botulism Q Fever Staph enterotoxin B pulmonary poisoning Viral Hemorrhagic Fever Brucellosis Ricin poisoning Tularemia

Category 2 Brucellosis Campylobacteriosis Chanchroid Cholera Cyclospora Cryptosporidiosis Ehrlichiosis Escherichia coli Giardiasis (acute) Guillain-Barre Syndrome Hemolytic Uremic Syndrome Hepatitis, Viral 1. Type B acute 2. Type C acute

Influenza Legionellosis Leprosy (Hansen Disease) Lyme Disease Malaria Psittacosis Rabies – animal Rocky Mountain Spotted Fever Salmonellosis – other than S. typhi Shiga-like Toxin positive stool Shigellosis Staph aureus Methicillin ResistantInvasive

Strep pneumoniae Invasive Disease 1. Penicillin resistant 2. Penicillin sensitive Tetanus Toxic Shock Syndrome 1. Straphylococcal 2. Streptococcal Trichinosis Vancomycin Resistant Enterococci Invasive Varicella deaths Vibrio infections Yellow Fever Yersiniosis

:_____________________________________________________

Employee Signature ______________________________________________________

Reviewed by:

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___________________ Date _____________________ Date:


DOCUMENTATION OF SERVICES Each employee documents services performed at each visit. This includes a services rendered checklist that each member signs and initials. The employee signs and submits weekly. The supervisor or scheduler will review and initial. When changes or issues occur with the member or client, employees complete a Client Changes Reporting Form and submit to the Case Manager and/or Program Director. A case management note documents any action taken and is placed in the member’s file. The Administrative Coordinator completes a Monthly Supervisor Form to verify services rendered and member/client satisfaction. Any concerns or suggestions are addressed. The Case Manager conducts home visits on a quarterly basis and completes a Home and Community Based Program Supervision Form. If there are imminent concerns, the Case Manager will conduct an emergency visit. TRAINING Upon initial orientation, every new employee is trained on using the EVV System (telephony and Santrax Point of Care - GPS device) and how to accurately complete the Home and Community Based Program Weekly Report. Proper documentation is discussed quarterly with all staff at each staff meeting/inservice training. CASE RECORDS Meritan Policy RPM 7 provides case record management and record keeping procedures. Documented case records must be maintained from intake through case closing (and the record maintained until the destruction date has passed). All entries made in the case records are signed and dated by the person who provided the service. See Policy RPM for complete details of documentation and compliance for case records.

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REPORTING CLIENT CHANGES As a HCBS staff member you will be presented with opportunities to report changes in a client's circumstances or status to Case Managers, Scheduling staff and Program Director staff. The following procedure/form has been adopted and put in place for you to report those changes as quickly as possible. PURPOSE ●

To provide HCS a form to report any changes in a client’s care. For example, a client enters the hospital for a few days. This change needs to be recorded and shared with Case Management and Scheduling staff.

To provide clients a form to report changes in their circumstances. An example of this could be the client reporting that they are going on vacation.

To provide HCBS office staff a form to record information reported by clients about changes in their circumstances.

(See attached HCBS Client Changes Form)

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REPORTING CLIENT CHANGES Client Changes Reporting Form Home and Community Based Services ☐SSBG Homemaker ☐CHOICES BlueCare ☐CHOICES Amerigroup ☐HOPWA ☐ VA Date: ___________________ Client Name: __________________________________________________________________ Client Address: ________________________________________________________________ Please use the space below to report any issues or significant changes observed while providing services. _____________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Home Care Specialist: __________________________________________________________

**Do not write below this line** Intervention/ Outcome: __________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Case Manager: _______________________________________ Date: ___________________

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HANDLING CONSUMER FUNDS Meritan employees will assist consumers in securing groceries, prescriptions, etc. on a case by case basis. If the consumer is unable to obtain or secure groceries, prescriptions, etc., without assistance from a family member or friend, you will use the following procedure when assisting the client. â—? â—?

You will only manage cash or EBT cards. No credit cards or debit cards. Checks must be made payable to the merchant.

Handling of Cash You will complete the Funds Receipt Form. The client must initial the form along with the employee acknowledging disbursement of cash amount. You will complete errand and return to the client the receipt for the merchandise and the correct change. You and the client will initial to acknowledge they received the receipt and the correct amount of change.

Handling of EBT Card You will complete the Funds Receipt Form. The client must initial the form along with the employee confirming the beginning balance on the EBT card. You will complete errand and return to the client the receipt for the merchandise and the EBT card. You and the client will initial to acknowledge they received the receipt and the EBT card.

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HANDLING CONSUMER FUNDS FORM Date: _________________________ Employee Name: ______________________________________________________________ Consumer Name: ______________________________________________________________ MONEY SOURCE DO NOT TAKE CREDIT, DEBIT, OR GIFT CARDS UNLESS PRIOR APPROVAL ☐ Cash

Cash amount $

☐ EBT Card

Beginning balance

$

PURCHASES OR BILL PAYMENT Amount of purchases $ Store or Business Amount returned to Consumer $ Receipt given to Consumer ☐ Yes

☐ No

CONSUMER SECTION Please initial one of the following: ● ● ● ●

My EBT card was returned to me I received a receipt for the purchases I received a receipt for the bill paid for me Only items I requested were purchased

Comments: _______________________________________________________________________ _______________________________________________________________________ Consumer Signature: ______________________________________________________

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EMERGENCY CONTACTS

AGENCY CONTACTS AVP_________________________________________ Program Director ______________________________ Scheduler ____________________________________ Adminstrative Coord. ___________________________

Phone #________________________ Phone # _______________________ Phone # _______________________ Phone # _______________________

IMPORTANT NUMBERS Ambulance/Fire/Police 911

Medication Assistance (901) 545-4630

Poison Control 1-800-222-1222 or 911

Commodity Program (901) 522-8268

MLGW Utility Assistance (901) 545-3220

Weatherization Assistance (901) 545-3230

MIFA Meals

MIFA Express Pay per

(901) 529-4567

(901) 529-4588

Ride ****keep this form with you at all times**** HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 37


CONFIDENTIALITY POLICY: HIPAA / HITECH COMPLIANCE Patient confidentiality must be maintained by all staff. All recipient material and information whether verbal, written, computer data or otherwise, shall be regarded as confidential information in accordance with the provision of HIPAA, Federal and State Law and ethical standards of conduct. The patient shall not be required to make public statements which acknowledge gratitude to Meritan or for the services provided. When you are in the home providing services for a patient, do not discuss other patients. Some of our patients live close to one another and know each other. They may or may not know that each receives services from Meritan. Patient's’ needs must be evaluated and determined by professional staff in order for Meritan to provide services. Each patient is viewed individually and has different needs. Do not discuss your patient’s services or needs with other patients. Whatever is discussed at the office, in a meeting or over the telephone with you is not to be discussed with your patients or the patient’s family. Anything that may occur at the patient’s home, which may affect you, or your patient should be called into the office and reported. DO NOT discuss your personal business or problems with your patient or the patient’s family. Do not discuss other patients or other aides with your patients. Do not give the patient’s telephone number to your family or friends (to contact you). Do not give your home, cell phone, or pager number to the patient/caregiver. Contact should be made through the scheduling department.

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HIPAA / HITECH: A Primer Helping you keep patient information private and secure in the digital era.

This notice describes how personal protected health information (PHI) is used and secured in the digital area. Please review it carefully. HIPAA in the Digital Age Meritan will follow the privacy practices that are described in our Notices of Privacy Practices. This notice took effect April 14, 2003. The notice will remain in effect until it is revised or replaced. The Health Information Portability and Accountability Act of 1996 (HIPAA), and the 2013 HIPAA Omnibus Update, established national standards for electronic transactions surrounding electronic protected health information (“ePHI”). The law provides guidance on the Privacy and Security of ePHI as handled by providers, health insurance plans, and employers. This notice is intended to provide some basic guidance for providers on how various HIPAA regulations interact with the use of text messaging, mobile devices, email, and mobile apps. Meritan’s Notice of Privacy Practice ensures that patients have the right to request to review and submit corrections to a Meritan (a “covered entity”) for any inaccurate PHI maintained by the covered entity (CE). PHI is any information held by a covered entity which concerns a patient’s health status; the provision of health care; or payment for said health care that is associated with an individual. Covered entities (CE) are required under HIPAA to disclose PHI to the patient within 30 days upon request, with certain caveats. The US Department of Health and Human Services (HHS)’ Office of Civil Rights (OCR) maintains resources on HIPAA Privacy for individuals and for professionals. Enhanced HIPAA enforcement: The new HITECH Act The new HITECH Act promises more rigorous enforcement of HIPAA (Health Insurance Portability and Accountability Act of 1996). The legislation includes mandatory penalties for “willful neglect.” Penalties can be expensive: as much as $250,000, with repeated or uncorrected violations carrying fees as high as $1.5 million. State attorneys general still will be responsible for bringing cause of action, but Health and Human Services is now legally bound to conduct audits of entities covered under the act as well as related business associates.

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HIPAA / HITECH: A Primer Helping you keep patient information private and secure in the digital era.

Breach notifications The HITECH Act requires practices to notify patients of any unsecured data breaches related to Protected Health Information (PHI). If a breach affects 500 or more patients, HHS must also be notified. Notification requirements are triggered whether the breach occurs internally or externally. Electronic Health Record Access The act requires patients and designated third parties to be given access to their PHI in an electronic format. This applies to providers who have implemented an EHR system.

******************

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HIPAA / HITECH: A Primer Helping you keep patient information private and secure in the digital era.

Training Acknowledgement Form I acknowledge that I have taken the training provided by Meritan concerning the Health Insurance Portability and Accountability Act (HIPAA), and the Health InformationÂ

Technology for Economic and Clinical Health Internet Act of 2009 (HITECH), and I acknowledge that I have had the opportunity to ask my supervisors about any portion of this training that I did not understand or that I have questions concerning. I will comply and am aware we have policies and procedures to comply with HIPAA/HITECH. I understand that client protected health information is to be kept private and only accessible on a need to know basis. I am aware that a privacy policy is contained in the Employee Manual and Policy and Procedure Database.

Signature ___________________________________________________________________ Printed Name ________________________________________________________________ Date __________________________

Supervisors / Program Director Signature ___________________________________________ Date ___________________________

HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 41


EMERGENCY PREPAREDNESS An emergency can occur at any time and place. When it does, you may not have much time to react. Emergency planning and training directly influence the outcome of an emergency situation. You can cope best by preparing for an emergency before it happens. Meritan has developed an emergency preparedness and disaster plan so that each person will know what, when, and how to handle unexpected events. The purpose of our handbook is to assist Meritan home care staff in handling emergencies according to the type, severity, and location. An emergency plan, in the most basic sense, is a guiding document that outlines in detail the systems and protocols which an organization has in place to: ensure the safety of staff and patients, operate within the larger emergency management system, and maintain continuity of services to patients during and after an emergency. The protocols outlined in our handbook are best-practices recommended through consultation with experts working in the safety/disaster preparedness field. The type of emergencies covered by an emergency plan could include natural incidents like flooding, hurricanes, or winter weather conditions; infectious disease outbreaks; man-made disasters or accidents which cause widespread exposure or dangerous conditions; and others outlined further in our handbook. The Centers for Medicare & Medicaid Services (CMS) has adopted (484.22 Condition of participation: Emergency preparedness) a basic framework and guideline structure for emergency planning. Meritan’s response plans are comprehensive, agency-wide and provide explicit protocols requiring all organizational staff and departments to work together under a shared understanding and collaborative effort. The Meritan Emergency Preparedness & Disaster Manual will help establish protocols for meeting the needs of patients while maintaining continuity of operations through a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action.

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EMERGENCY PREPAREDNESS Staff Acknowledgement and Receipt of Handbook I, _____________________________________________________ acknowledge that I received training on Emergency and Disaster Preparedness as part of orientation / annual ongoing training.

I also acknowledge that I received this training and an Emergency and Disaster Preparedness handbook on _________________________ (date).

I am aware that this emergency and disaster preparedness handbook helps establish protocols for meeting the needs of patients while maintaining continuity of operations through a coordinated and continuous process of planning and implementation.

I am aware that if I have any questions regarding Emergency and Disaster Preparedness I need to ask the Program Director of Assistant Vice President of Homemaker Services for clarification.

___________________________________________ Printed Name

______________________ Date

___________________________________________ Signature

______________________ Date

___________________________________________ Program Director

______________________ Date

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HCBS SETTING RULE - POLICY HCBS Setting Rules focus on the experience of each person receiving services and supports. The goal is to ensure that every person has access to benefits of community living, has full opportunity to be integrated in their community, and has enhanced protections. The rules DO NOT apply to nursing homes, hospitals, institutions for mental diseases, ICFs/IDs, facilities or homes located in a public or privately-operated building that provides inpatient institutional treatment, located on the grounds or next to a public institution, or has the effect of isolating HCBS members from others that do not receive Medicaid funded HCBS. Isolation is considered, but not limited to, gated or secured communities, and multiple settings located together and operated by the same provider. Meritan will ensure we provide each HCBS members with the ability to integrate with the community; ability to choose their settings; respect their rights to privacy, dignity, respect, and freedom from coercion and restraint; and independence to make life choices. Each member’s Plan of Care will address the HCBS Setting Rules to ensure compliance. Quarterly visits are conducted to address any issues or concerns. There will be instances when the HCBS Setting Rules cannot be followed. Meritan will: ● ● ● ● ●

Document attempts to try other strategies Document the rule not being followed and the reason why in the member’s Service Plan Ensure member and/or responsible party agrees Ensure non-compliance with the Rule will not cause harm Track and document that the change is working

Training Meritan will document initial training on the HCBS Setting Rules. An orientation checklist which documents the training is signed and placed in each employee’s file. All employees will receive training annually.

HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 44


OUR PROGRAMS SSBG, VA, HOPWA, CHOICES, PRIVATE PAY Meritan’s Home and Community Based Services Division operates six (6) programs. Apelah’s Home and Community Based Services Division operates four (4) programs.These programs are our funding source (or funders) and make up how we operate and provide services to clients and salaries to employees. Each funder has specific and legally binding requirements (sometimes referred to as ‘standards’). If an agency violates these standards there are a number of penalties (called compliance issues) and can range from out of compliance letters to the loss of the funding contract. Here at Meritan we take seriously the standards of performance set by our funders. SSBG: SSBG is known as the Social Services Block Grant and is a program funded through the Federal and State Government. Persons authorized by the TN. Department of Human Services in need of protective services who are unable to protect their own interests due to mental or physical dysfunction and are at risk for neglect, abuse, or exploitation are referred into the program. Clients must be 60 years or older or disabled, frail, and/or low income. Their income must not exceed 125% of the Federal Poverty Guideline. A person receiving AFDC or SSI is automatically eligible for services if the need is present. SSBG falls under Home and Community Based Services so our direction needs to be more person-centered in our care plans (which will include HCS staff in helping to develop care plans as we move forward), we are also looking at the eligibility/discharge requirements (the program is to designed to provide protective supervision for adults, homemaker services and “the provision of temporary care to help the adult return to or remain in his/her own home.”

VA: Veteran’s Home and Community Based Services is exactly like our other Homemaker Programs but specifically targeting Veterans. Referrals are received from the VA and authorization from these services also comes from the Veterans Administration. HOPWA: We currently provide supportive home and community based home care services to individuals diagnosed with acquired immunodeficiency (AIDS) syndrome. The Home Care Specialist provides assistance and support with ADL’s, access to services and social interactions. We currently served Shelby County and will be expanding into DeSoto County with our move into Mississippi with our Private Pay program.

HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 45


OUR PROGRAMS SSBG, VA, HOPWA, CHOICES, PRIVATE PAY CHOICES: Tennessee CHOICES program provides older adults & adults with physical disabilities who are eligible with needed long-term services and supports in the home/community setting or in a nursing facility. Because this is an insurance reimbursable program documentation of services is extremely important...if there are changes or issues occur please remember to complete a Client Changes Reporting Form and submit to the Case Manager and/or Program Director. Private Pay: Individuals don’t need to meet a certain age restriction for private pay, however, these are non-medical support services intended to assist the clients with activities of daily living (ADL’s) to promote a safer and healthier living environment, to ensure the client's basic needs are being met and allows the client to be more self-sufficient in their own homes. Private Pay simply means there is no insurance and the client pays out of pocket.

HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 46


CONSUMER SAFETY:

Basic Home Safety

A. Report unsafe conditions immediately to the supervisor. B. Clean up after yourself to prevent falls on wet floors or skin punctures due to carelessly left needles. C. Instruct clients/caregivers in keeping pathways clear. D. No equipment should be used by an employee unless they have the proper knowledge in its use and safety features. E. Do not physically attempt any task if you are doubtful. F. Dispose of all equipment as indicated by infection control policy. G. Use safety devices on equipment in homes, such as: 1. Lock wheelchair wheels prior to transfers. 2. Utilize side rails when available. H. Follow infection control procedures at all times. I.

Be knowledgeable in contacting police, rescue squad, fire department and poison control centers in the area (911). Review the evacuation plan or the assigned sheet upon entering the home.

J. Keep all clients’ care items out of reach of children. K. Explain all procedures to clients and caregivers prior to beginning procedure. L. Do not use any equipment in the home that appears to be functioning improperly. M. Instruct and document oxygen safety: 1. There should never be smoking in rooms where oxygen is present. 2. There should be a no smoking sign posted. 3. Do not use electrical appliances on client when oxygen is on (hair dryers, electric shavers, heating pads) 4. Reduce possibility of static electricity. 5. Document non-compliance of client/caregiver to any of above. N. Do not leave confused/disoriented/unstable clients alone in unsafe environment; notify supervisor immediately. O. Notify the office if smoke detector is not working or not mounted on the wall. HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 47


CONSUMER RIGHTS Meritan is committed to preserving the confidentiality and privacy of all our consumers while providing the best quality of services available. A cornerstone of all Meritan programs is the trusting relationship, which is shared between the Home Care Specialist, Case Manager and the consumer. To protect that alliance, it is important that consumers are aware of their rights as a client of Meritan as well as some special limitations upon those rights as required by law. If consumers have questions regarding their rights, they are instructed to discuss them with their case manager. Consumers have the right to expect professional and courteous service. Consumers have the right to the services of the Agency without discrimination regarding sex, race, gender, sexual orientation, race or ethnicity, creed, religion or national origin. Consumers have the right to be informed if this Agency cannot provide the services to meet their needs. Consumers have the right to have the nature of the services and related recommendations explained to them. Consumers have the right to participate in the development of their service plan, which will be individualized for the consumer. Consumers have the right to refuse to participate in clinical research and studies. Consumers have the right to refuse recommended services while recognizing that their refusal may result in the inability of Meritan to provide adequate services and the potential impact. Consumers have the right to privacy and all guarantees under the HIPAA regulations. Consumers have the right to confidentiality. For the most part, no information concerning them or the services they receive at Meritan may be given to others outside of Meritan without written consent. Exceptions to this include the mandatory reporting of abuse, concern about dangerous activity toward oneself or someone else, and information court-ordered by a judge for legal purposes. Consumers have the right to read their written records while on the premises of the Agency in the presence of a professional staff member. Consumers have the right to file a grievance if they believe that any of these rights have been violated. Consumers have received a copy of these rights at the time of intake. HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 48


CONSUMER GRIEVANCE Meritan, Inc. wishes to ensure that each person in all of our programs is adequately served. Occasionally, problems may arise, and we ask that you report these to the Director of the program you are receiving services from. Every effort will be made to resolve any problems that occur in a satisfactory manner. Whenever a consumer voices a grievance about services, the staff member working most closely with the consumer should address it to the limits of his or her authority. If a consumer continues to be dissatisfied, he or she should be asked to submit the grievance in writing and request a meeting with the Program Director. If the consumer is unable to do so, it is the responsibility of the staff member to notify the Director by transcribing the consumer’s complaint in writing. Upon receipt of a consumer grievance, the Program Director should contact the consumer within five (5) working days and arrange a meeting at a mutually convenient time and place. The Program Director will submit copies of the grievance to the appropriate Vice President and General Counsel, Director of Compliance and Human Resources. Within five (5) working days following the meeting, the Director will provide a written response to the consumer. The Director will read this response to the consumer if needed. The Program Director will submit copies of the written response to the appropriate Vice President and General Counsel, Director of Compliance and Human Resources. This written response includes instructions for appeal if the grievance is not resolved to the consumer’s satisfaction. Instructions for appeal include the appropriate Vice President's name and mailing address and the need to submit the appeal in writing. The Program Director will assist the consumer if needed. Upon receipt of an appealed grievance, the Vice President will contact the consumer to arrange a mutually convenient meeting within five (5) working days and submit a copy of the written appeal to the General Counsel, Director of Compliance and Human Resources. Within five (5) working days following the meeting, the Vice President will provide a written response to the consumer. This written response includes instructions for appeal to the funding or state agency. The Vice President will read this response to the consumer if needed. The Vice President will submit copies of the written response to the General Counsel, Director of Compliance and Human Resources. Services will continue during the efforts to resolve any complaint, and staff will be available to the consumer during the grievance process.The General Counsel, Director of Compliance and Human Resources will track grievances and the resolutions.

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TITLE VI CIVIL RIGHTS POLICY The agency complies with Title VI of the Civil Rights Act of 1964 (45 CFR, Part 80) which states: “No person in the United States shall, on the grounds of race, color, or national origin, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance� Any program participant or potential beneficiary of any program who suspects denial of any services, benefits or financial assistance, on the basis of race, creed, color, sex, age or national origin, or who suspects that such factors affect the quality, quantity, or range of services, benefits or financial assistance extended, shall have the right to file a complaint in accordance with Title VI of the Civil Rights Act and established procedures and to expect a proper investigation of the complaint. Complaints may be referred to the Title VI Coordinator at telephone number, (901) 766-0600. Employees violating this policy are subject to discipline and/or dismissal. Vendors and foster parents are subject to sanctions and/or termination of the contract. Complaints must be submitted in writing to: Title VI Coordinator, 4700 Poplar Avenue, Suite 100, Memphis, TN 38117 and will be investigated and resolved by an internal committee.

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NON-DISCRIMINATION IN SERVICES Any provisions of services shall be made to all agency consumers without regard to age, gender, race, ethnicity, national origin, religious background, marital status, sexual orientation, or disability. Meritan’s facilities shall be made accessible to eligible disabled persons, through the most suitable method available. These methods may involve equipment redesign, the provision of aids, and alternative locations. Any structural modifications would be considered only as a last resort and upon the approval of the Board of Directors. Anyone who believes he/she has been discriminated against may file a complaint of discrimination with:

Asia Diggs Meadows, JD, SPHR, SHRM-SCP General Counsel, Vice President of Compliance & HR Meritan, Inc. 4700 Poplar Avenue Memphis, TN 38117

HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 51


WEEKLY REPORTS (DAILY SHEETS) HOME AND COMMUNITY BASED SERVICES HOMEMAKER WEEKLY REPORT FORM INSTRUCTIONS

Home Care Specialist complete the Home and Community Based Program Weekly Report for each client (member) weekly. The Home Care Specialist marks the specific task that were performed. The form is reviewed and initialed by the Supervisor. DO NOT USE LIQUID PAPER IF YOU MAKE AN ERROR. CROSS THROUGH THE ERROR, CORRECT, AND INITIAL. 1. Complete a report for each client. Print client name at top of form.

2. Indicated the date you arrive at the client’s home. 3. Indicate the time that you arrive at the client’s home. 4. Indicate the time you leave the client’s home. 5. Indicate the total service time for the day. 6. Make sure the client signs (or marks) the form (next to staff signature) 7. Check which program the client is enrolled in and check the appropriate box 8. Only check activities that are in the Client's Plan of Care / Person Centered Plan. 9. If you make a mistake on the form do not erase or use white out. Draw a line through the error, initial and rewrite. 10. Sign your name 11 .Submit forms each week

****See Sample Weekly Report Attached***

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MISSED VISITS HCBS Homemaker Program Missed Visit Report

⬜SSBG Homemaker ⬜VA ⬜Blue Care ⬜Amerigroup ⬜HOPWA ⬜Private Pay Client Name: ____________________________________________________________ Date of Missed Visit: ________________________________________________________ Type of Visit: O Homemaker (SSBG, CHOICES, HOPWA, VA, Private Pay) O In Home Respite O VA Caregiver O Attendant Care (CHOICES) O Personal Care (CHOICES) Reason for Missed Visit: (Mark only 1 Reason) O Client had unscheduled appointment O Client and/or family refused alternate staff member services O Client refused services O Hazardous weather O Scheduling error O Client unavailable: (reason) ______________________________________________ ______________________________________________________________________ O Knocked – no response O Called – no answer O Provider unable to provide service / Related To: ______________________________________________________________________ ______________________________________________________________________ Comments: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________________ Signature of Agency Representative

________________ Date

Please complete and file HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 53


COMMUNICATION RESOURCES For consumers with special communication needs the following procedures are to be used: 1. The consumer may bring their own interpreter as long as the consumer signs a Release of Information Form so the interpreter may participate in the interview. The interpreter must sign a Confidentiality Statement. 2. If no staff persons if available to interpret, a community resource will be utilized. 3. Meritan will pay the cost of the interpretive services. 4. Each program outside of Memphis will identify local community resources that are available to interpret and provide a list of these resources to the staff. 5. Each program will update their list of available interpreters annually. Interpretive Resources in Memphis 1. Interpreting Services for the Deaf 144 North Bellevue, Memphis Voice: 278-9307 TTY: 278-9030 2. Associated Catholic Charities – most languages 1325 Jefferson, Memphis Phone: 722-4700 3. Jewish Family Services – most Eastern European languages 6560 Poplar, Memphis Phone: 767-8511 4. Latino Memphis 2838 Hickory Hill #25, Memphis Phone: 901-366-5882

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WHISTLEBLOWER ACT / DEFICIT REDUCTION ACT The Deficit Reduction Act of 2005 is a piece of legislation passed by Congress that included provisions impacting federal healthcare programs. This includes any plan that provides health benefits which are funded by the U.S. government, or any state healthcare program defined under section 1320a-7(h). The False Claims Act covers liability for certain acts (Title 31, Section 3729). Any violation listed below will result in civil penalties of no less than $5,000 and not more than $25,000 plus three times the amount of damages. Knowingly presents to an officer or employee of the U.S. Government or member of the Armed Forces of the United States a false or fraudulent claim for payment or approval. Conspires to defraud the Government by getting a false or fraudulent claim allowed or paid. Authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government without completely knowing that the information on the receipt is true. Knowingly makes, uses, or causes to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the Government. Knowingly makes, uses, or causes to be made or used, a false record to statement to get a false or fraudulent claim paid or approved by the Government. Has possession, custody, or control of the property or money used, or to be used, by the Government, and willfully conceals the property or delivers less property than the amount for which they receive a certificate or receipt. Employees are protected from retaliation by the False Claims Act. Employees must reasonably believe they are reporting a violation of the law. Meritan will not discharge, demote, suspend, harass or in any manner discriminate against the employee reporting the violation. How to Report Call the Bureau of TennCare from anywhere in Tennessee at 1-800-433-3982 -or- log onto: http://www.tn.gov/tnoig/ReportTennCareFraud.shtml to complete an online form or to download a form to mail of fax to the State of Tennessee.

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CRITICAL INCIDENT / REPORTABLE INCIDENT PROCESS

Why is Critical Incident Training Important? There are three reasons why Critical Incident training is important: 1.

Appropriate training must be provided and corrective actions taken as needed to ensure staff, (staff in all program areas) comply with critical incident requirements from all funders. 2. Training must be provided to employees regarding reporting, and cooperating with the investigation of any critical incidents; and training consumers and caregivers regarding critical incident reporting and management. 3. Training must include education for staff on what to expect once a report is made to BlueCare/HCBS for any incident type; or APS for abuse, neglect or exploitation. What is a Critical Incident? A critical incident is any event listed in the definitions below that occurred in a HCBS (Home and Community Based Services, long term service and support setting. The incident may occur within the provisions of covered CHOICES HCBS services as a reportable or non-reportable event, or the incident may be discovered or witnessed by another provider. The following are Critical Incident Types (for all of our funders): ●

Any unexpected death – of a CHOICES member (client) or HCBS client, regardless of whether the death occurs during the provision of HCBS services.

Suspected physical or mental abuse – infliction of injury, unreasonable confinement, intimidation or punishment with resulting harm, pain or mental anguish.

Theft – knowingly obtaining or exercising control over the property/medication of another without their consent.

Financial exploitation – Unauthorized, improper or failure to use the member’s funds, property, or other resources according to a member’s desires or well-being.

Severe Injury – An injury that requires assessment and treatment beyond basic first aid that can be administered by a lay person.

Medication error – Any incorrect or wrongful administration of a medication to a member.

Sexual abuse and/or suspected abuse - Inflictions of injury, unreasonable confinement, intimidation or punishment of a sexual nature with resulting harm, pain or mental anguish HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 56


CRITICAL INCIDENT / REPORTABLE INCIDENT PROCESS Abuse and neglect and/or suspected abuse – Failure to provide goods or services necessary to avoid physical harm, mental anguish, or mental illness, which results in injury or probable risk of serious harm. FOLLOW THE CRITICAL INCIDENT PROCEDURE FOR EACH FUNDER Timelines / What to Do? Date of Discovery: The date and time the first person/entity discovered the critical incident ●

Within 24 hours of detection or notification, any unexpected death and/or incident reported to APS (888-277-8366.) must be reported to BlueCare via written or verbal report if the client is a CHOICES client. If not a CHOICES client after APS report, contact Case Manager or Program Director.

If this is a CHOICES/MCO Client you must also call the MCO. Reporting is required as soon as possible and within 24 hours of date of discovery. Report may be verbal via telephone at 1-888-747-8955 or written via email at CHOICESQuality@bcbst.com or via fax 855-292-3715. You DO NOT call the Supervisor first.

A written report on specific MCO form is required within 48 hours of discovery.

You must also call APS within 24 hours of discovery if abuse, neglect, or exploitation is suspected. .

A comprehensive follow-up report is submitted within 20 calendar days of discovery to MCO’s. All information is submitted to MCO no later than 30 calendar days from discovery.

If member is IMMINENT DANGER, you need to call 911 immediately.

If the incident requires law enforcement...after law enforcement has arrived, call APS and speak to a live representative. If voicemail picks up, leave a message and use the words “IMMINENT DANGER.” Continue to call every few business hours until you can talk to a live person or a call back is received.

After you call APS, you must call the Supervisor/Program Director immediately with the date, time, and who you suspect committed the incident, if applicable. You must also report the date, time, and the person you spoke to at APS. If you left a message, please note the time you left the message.

Once report has been made to Supervisor, you may be contacted by management staff, law enforcement, or MCO for additional information. You must make yourself available for additional questioning. You will be asked to provide all phone and fax numbers, and email addresses for follow-up. HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 57


CRITICAL INCIDENT / REPORTABLE EVENT PROCESS Staff Committing Acts of Abuse, Neglect, or Exploitation We believe in providing quality care to all members. We take these acts very seriously and there will be consequences to those participating in this type of unethical and/or illegal behavior. ● ●

If staff is suspected of abuse, neglect, or exploitation, you will be removed immediately from all schedules. You may be able to work in the office until the investigation is complete. If the allegations are substantiated, YOU WILL BE TERMINATED. You will also be reported to the appropriate abuse registries and law enforcement, if applicable.

Duty to Report to APS - Contact APS at 888-277-8366. ● ● ●

If in doubt, always err on the side of caution and make a report to APS. It is APS’ responsibility to make the decisions regarding abuse, neglect, or exploitation. There will not be any acts of retribution for reporting suspected abuse, neglect, or exploitation. Any person failing to make a report as required by the Adult Protection Act is guilty of a Class A misdemeanor and upon conviction may be fined not more than $2500 or imprisoned for not more than 11 months, 29 days or both.

Follow-Up Meritan’s Program Director or Designee will complete the Critical Incident Report for CHOICES by completely filling out section F & G of the report. This follow up report must include any conclusions and documented investigation findings and actions to be taken. This report must also include any statements from the worker on site at the time of the incident or a reason why the information is not included. Employment and Community First CHOICES (CISS/ILST) Reportable / Non Reportable Incidents Non-Reportable Events Non-Reportable events are not reportable outside of the provider agency and do not rise to the level of being considered a “critical incident”, but require providers to document, address the event and track and trend due to the potential to impact the member’s safety and quality of support. Non-reportable events are not reported to the MCO or DIDD except if a provider’s internal review determines the event rises to a level of a Tier 1, Tier 2 or a Tier 3 Medical/Behavioral Reportable Event.

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CRITICAL INCIDENT REPORTING PROCESS Reportable Events (Event that require reporting) There are 3 levels of Reportable events. See the grid of Reportable Events (attached). Tier 3 Tier 3 Reportable Medical and Behavioral Events are only reported to the MCO (not to DIDD) on the Reportable Event Report Form (RERF). Reporting and review of the incident is secondary to any medical attention required by the member. The incident, medical attention, and any follow-up shall be documented in the person’s record. The Program Director or designee will submit a written ECF Tier 3 Reportable Event Report Form via data exchange to the MCO within two business days after occurrence or discovery of occurrence. Tier 2 The Program Director or designee will submit a written ECF Reportable Event Report Form via data exchange to both DIDD and MCO by close of the next business day after occurrence or discovery of occurrence. The Program Director or designee is responsible for conducting investigations and submitting an investigation report to the MCO within 14 calendar days of the submitting the Tier 2 Reportable Event Form to the MCO. Tier 1 Tier 1 Reportable Events must be reported by the Program Director or designee immediately, but no later than 4 hours after occurrence or discovery of occurrence. Report to DIDD using appropriate hotline number at 888-632-4490. The Program Director or designee must submit a written, (preferably typed) ECF Reportable Event Report Form via data exchange to both DIDD and the MCO by close of the next business day after the telephone report to DIDD is made. The Program Director must submit a typed Reportable Event Form to DIDD and the MCO by close of the next business day counting from the date of verbal (telephone) notification. ● ● ●

DIDD via email @ECF.REF@tn.gov or fax if email is not available to 1-877-551-5591 BlueCare @ ECFCriticalIncident@bcbst.com or by fax @ 1-855-472-0156 if email is not available. Amerigroup via email @ tn01-qualitymanagement@anthem.com or fax @ 877-423-9976 if email is not available.

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CRITICAL INCIDENT REPORTING PROCESS Categories of Incident Grid Tier 1 Critical Incident Allegations or suspicions of abuse, neglect or exploitation resulting in serious injury to the person supported; 1. Serious injury is any injury requiring medical attention beyond first aid by a lay person, including (but not limited to); ● Fractures ● Dislocations ● Concussions ● Cuts or lacerations requiring sutures, staples, or Dermabond ● Torn ligaments (i.e., a severe sprain) or torn muscles or tendons (i.e. a severe strain requiring surgical repair ● 2nd and 3rd degree burns ● Loss of consciousness Allegation or suspicion of sexual abuse must be reported whether a serious injury occurred or not; All unexplained or unexpected deaths (including suicide); Serious injury of unknown cause.

Tier 2 Critical Incident

Tier 3 Reportable Medical Incidents

Person whose whereabouts are unknown and which will likely place him/her in a dangerous situation for self or others. Reportable within 60 minutes of the absence being discovered if the absence is unusual or the absence is a know risk as specified in the person’s PCSP (Person Centered Support Plan) or Behavior Support Plan (BSP). Note: Does not mean that person supported should not have freedom to come and go without staff supervision, except when such restrictions are necessary, which must be documented in the PCSP in accordance with the federal HCBS rule. ● Minor vehicle accident not resulting in injury ● Victim of fire ● Medication variance resulting in the need for observation, which may include the need to seek practitioner care or advice, but does not require in-person medical assistance, including physician services, emergency assistance or transfer to an

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● ●

● ●

● ● ●

Deaths (other than those that are unexpected/unexplained) ER visits Any inpatient observation or admission (acute care, LTAC, or SNF.NF) Use of CPR or an automated external defibrillator (AED) Choking episode requiring physical intervention (e.g, use of abdominal thrust or Heimlich maneuver), Fall with injury (including minor or serious) Insect or animal bite requiring treatment by a medical professional State II and above pressure ulcer Staph infection Fecal impaction


CRITICAL INCIDENT REPORTING PROCESS Categories of Incident Grid

Tier 3 Reportable Behavioral Incidents ● ● ● ● ● ● ● ● ● ●

Non-Reportable Incidents ●

Minor injury not identified above and not requiring medical treatment ● Staff misconduct that falls outside the definition of Tier 1 or Tier 2 Critical Incidents or REportable Medical and Behavioral Incidents and does not result in serious injury or probable risk of serious injury. Examples include: ● Not following PCSP/BSP/Dining Plan etc. when such action (or inaction would not pose a probable risk of serious injury, staff convenience; or minor traffic violations while transporting persons.

Criminal conduct or incarceration Engagement of law enforcement Sexual aggression Physical aggression Injury to another person as a result of a behavioral incident of a person supported Suicide attempt Self-injurious behavior Property destruction greater than $100 Swallow inedible/harmful matter Behavioral crisis requiring protective equipment, manual or mechanical restraints, regardless of type or time used or approved by PCSP (all take-downs and prone restraints are prohibited) Behavioral crisis

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CRITICAL INCIDENT REPORTING PROCESS

TRAINING ATTESTATION By signing, I acknowledge that I have participated in Critical Incident Training. I had an opportunity to address any questions or concerns. I understand that my supervisor is available to provide additional information.

____________________________________________________ Staff Signature

_____________ Date

____________________________________________________ Department Trainer / Designee

_______________ Date

____________________________________________________ Department Program Director

_______________ Date

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HCBS: TEST (A minimum of 80% is required to pass this test)

This test is the culmination of your in-class and online training requirements for HCBS Homemaker Program. A minimum of 80% is required to be considered a passing score. Please take your time and answer each question. Circle the best answer 1) Homecare Specialist are required to report changes in a consumer’s condition to their supervisor? T / F 2) Examples of Activities of Daily Living (ADL) skills include eating, toileting, mobility, bathing/hygiene, and dressing? T / F 3) It is not necessary to document the services provided to a consumer? T / F 4) It is ok to use white out or erase entries made in the consumer’s record? T / F 5) Elder abuse is: (Circle only one) a) Not against the law b) An act that cause harm to another person c) Only has to be reported if the person goes to the emergency room d) Violence that occurs to people ages 60 and over. 6) The consumer does not have a right to privacy and HIPAA regulations? T / F 7) Consumers have the right to be protected from abuse and neglect? T / F 8) Hands must be washed with soap and water after patient care only? T / F 9) The single most important thing a person can do to prevent spread of infection is to practice good hand hygiene? T / F 10)Smoking by the consumer and other persons in the house where oxygen is in use is prohibited? T / F

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HCBS: TEST (A minimum of 80% is required to pass this test)

11) Vehicle accidents should be reported to only your supervisor? T / F 12) A Thunderstorm is an example of a natural disaster in emergency preparedness? T / F 13) Emergency plans should be prepared prior to the threat of severe weather or other emergency? T / F 14) Changes in a consumer’s ability to perform daily living skills can occur because of tiredness, weakness, pain, illness, and depression. T / F 15) It is ok to use white out or erase on entries made in the consumer’s record? T / F 16) Elder abuse is violence that occurs to people ages 60 and over? T / F 17)The consumer is to be given a copy of their rights by Meritan? T / F 18) Infection control is the practice of stopping harmful organisms from entering the body? T / F 19) Proper food handling techniques include washing hands with hot/soapy water before and after handling food? T / F 20) The purpose of consumer rights is to ensure protection of the client? T / F ______________________________________________ _____________________ Staff Signature Date ______________________________________________ Trainer Signature

_____________________ Date

_________________ Score HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 64


LEADERSHIP TEAM Melanie Keller, President / CEO Jeff Weesner, Chief Administrative Officer Asia Diggs,General Counsel, Vice President of Compliance & HR Yolanda Webb, Division Vice President Home and Community Based Services Patricia Turner, Program Director Home and Community Based Services Gary Mccaa Russum, Program Director Home and Community Based Services

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HCBS Case Management / Homemaker / Operational Staff Training SOP 03/26/2018 / v.2 66


MERITAN HCBS HOMEMAKER PROGRAM “Doing Ordinary Things, ExtraOrdinarily Well”

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Hcbs orientation training program handbook  

Staff Training Handbook

Hcbs orientation training program handbook  

Staff Training Handbook

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