InHome Health Services

1
In-Home Health Services

• Carol Benner
• December 7, 2004
• Cbenner_at_dhmh.state.md.us

2
History

• 1980 Home Health Agency
• Definition Provides nursing, home health aide
  and 1 other service in the home (total of 3
  services)
• Eligible for Medicare payments
• Certificate of Need required
• Mid 80s Loopholes Identified
• OHCQ identified agencies, or agencies were
  reported to OHCQ, that avoided the CON process by
  offering only only 2 services
• 1988 Creation of Residential Service Agencies

3

• Residential service agency" means any person
  that is engaged in a nongovernmental business of
  employing or contracting with individuals to
  provide home health care for compensation to an
  unrelated sick or disabled individual in the
  residence of that individual. 
• "Residential service agency" includes any agency
  that employs or contracts with individuals
  directly for hire as home health care providers. 
  
• Home Health Care Services are identical to
  services provided by HHA
• List of 10 exclusions
• Essentially the same as HHA with no CON, less
  regulation

4

• 1989-1993 Lots of confusion about the definition
  of RSA what it was and what its not.
• 90s Concerns raised about other in-home health
  care services including nurse registries and
  nurse staff agencies
• 1997 Legislation passed creating a Task Force to
  study all in-home health care
• January 1, 1998, Task Force issued report
• Fragmented system
• Increased number of RSAs doing the same work as
  HHAs
• Need to regulate Nurse Staff Agencies and Nurse
  Registries

5

• 1998 Legislation introduced that proposed
  consolidating all in-home health care services
• Bill failed
• 2000 Legislation passed requiring regulation of
  Nurse Staff Agencies
• 2003 Legislation passed making Nurse Registries a
  component of RSAs
• 2004 Legislation passed giving Nurse Registries
  its own category - Nurse Referral Service
  Agencies (NRSA)
• 2004 Legislation introduced to regulate Chore and
  Companion Services sent to summer study
• 2004 DHMH convened workgroup to look at in-home
  health care

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In-Home Health Services Work Group

• Looking at all categories of in-home health
• Includes all stakeholders
• Meetings are open
• Minutes and meeting notes are posted on the OHCQ
  website (www.dhmh.state.md.us/ohcq/cbhsforum/home.
  htm)
• First meeting was successful
• Too early for recommendations
• Expect report next fall

7
2004 -- Types of In-Home Services

• Home Health Agency (HHA)
• Residential Service Agency (RSA)
• Nurse Referral Services Agency (NRSA)
• Hospice (HO)
• Private hires of individuals to perform nursing,
  aide, or companion services

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Who Pays for Services?
9
What Services are Provided?
10
HHA and RSA
NRSA
Chore and Companion
11
Number of HHAs, RSAs, NSRAS
12
Chore and Companion Services

• Component of HHA, RSA, NRSA
• 2004 Bill introduced to regulate separately
• Minimal requirements that include criminal
  background check and surety bond
• Todays Question Do we move forward or wait
  until the workgroup makes recommendations?