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    RELS

     Homecare Corp

Due to Covid-19 we have adjusted our training methods.  Please see below

How to report 

For Medicare:

 US Department of Health and Human Services (HHS)

 Call 1-800-Medicare (1-800-663-4227)

 TTY users call 1-877-486-2048

 Online at https://oig.hhs.gov

For Medicaid:

 Michigan Department of Community Health (MDHHS)

 Phone (toll free): 1-855-MI-FRAUD (1-855-643-7283)

 Online: www.michigan.gov/fraud

 Write: Office of Inspector General (OIG), PO Box

30479 Lansing, MI 4890

Critical Incidents that must be reported

Exploitation – Required to report to APS

 Neglect – Required to report to APS

 Verbal abuse – Required to report to APS

 Physical abuse – Required to report to APS

 Sexual abuse – Required to report to APS


 Illegal activity in the home with potential to cause a serious or major negative event - local authorities/police

 Suspicious or Unexpected Death Death should be reported to law enforcement if it is a suspicious death possibly linked to abuse or neglect.  (TSA)

  Training tools

Direct Support Caregivers

You are important to the person-centered process because you…

 Know the person You understand what is important to the person

you understand the person’s communication style/nonverbal

communication Have a trusting relationship with the person

  Support the person in different environments You

 Are the individual the person turns to for assistance and support.

 Your job is to encourage and support the individual while providing necessary daily care to keep them safe in their homes. 

You are clearly an important part of each person’s life.  (tsa)

Fraud

Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care

benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the

money or property owned by, or under the custody or control of, any health care benefit program. The Health Care Fraud

Statute makes it a criminal offense to knowingly and willfully execute a scheme to defraud a health care benefit program. This applies to the fraudulent completion and submission of

timesheets/cards in order to collect payment for hours not worked.

Waste & Abuse

Waste includes overusing services, or other practices

that, directly or indirectly, result in unnecessary costs

to the Medicare Program. Waste is generally not considered to be caused by criminally negligent but rather by the misuse of resources. (CMS)


Abuse includes actions that may, directly or indirectly,

result in unnecessary costs to the Medicare Program.

Abuse involves payment for items or services when there is not legal entitlement to that payment and the

provider has not knowingly and/or intentionally misrepresented facts to obtain payment. (CMS)

Culturally Competent Healthcare Training - Module 4: LGBTQ and Immigrants/ Refugees

Topics include: Health disparities among LGBTQ population, clear communication guidelines for healthcare providers interacting with LGBTQ patients, disparities among immigrant and refugee communities, and clear communication guidelines for healthcare providers interacting with immigrant and refugee patients

Culturally and Linguistically Appropriate Resources / Disability Resources (Molina Healthcare of Michigan)


Introduction to Cultural Competency


Culture competence is the capability of effectively

dealing with people from different cultures. 

Health Disparities


 Seniors and Persons with Disabilities

People with disabilities are individuals with families, jobs, hobbies, likes and dislikes, and problems and joys. While the disability is an integral part of who they are, it alone does not define them. Don't make them into heroes or victims. Treat them as individuals.

Becoming Culturally Competent

  

Personal Centered Planning

A set of approaches designed to assist someone to plan life and supports. It is used most often as a life planning model to enable individuals with disabilities, or otherwise, requiring support to increase their personal

self-determination and improve their own independence It shifts power back to the participant People are the expert of their own lives. Getting to know the person is the core of person centeredness. We learn:

 How the person wants to live

 Builds upon their capabilities

 Honors their preferences, choices, desires, and needs.

Mandated Reporters

A person who is employed, licensed, registered, or certified to provide health care, educational, social

welfare, mental health, or other human services; an employee of an agency licensed to provide health

care, educational, social welfare, mental health, or other human services; a law enforcement officer; or

an employee of the office of the county medical

examiner who suspects or has reasonable cause to believe that an adult has been abused, neglected, or

exploited shall make immediately, by telephone or otherwise, an oral report to the county department

of social services of the county in which the abuse,

neglect, or exploitation is suspected of having or believed to have occurred. (Social Welfare Act - Act 280 of 1939, 400.11)


(tsa)

What is HIPAA? 

A broad federal law passed in 1996 due to the rapid

growth of health information systems and the need to

safeguard individuals’ health information. That also

addresses many health care privacies, security and

electronic billing issues. It improves portability and

continuity of health insurance coverage in the group

and individual markets, and simplifies the

administration of health insurance.

• In some cases, states may have different rules and restrictions. If the state laws are more stringent than those found in HIPPA we must follow the state’s

regulation.

Privacy Standard

• The Privacy Rule is a set of national standards for the

protection of certain health information.

• These standards address the use and disclosure of individuals’ Protected Health Information (PHI) by

organizations.

• PHI – Individually identifiable health information.

(tsa)

The Platinum Rule

• What is the Platinum Rule?

• Do unto others as they would want done to them

• The Golden Rule, as great as it is, has limitations, since all people and all situations are different. When you follow the Platinum Rule,

however, you can be sure you're actually doing what the other person

wants done and assure yourself of a better outcome.

(tsa)

Mandated Reporters continue

Direct Care Providers have a legal responsibility to report

suspected abuse, mistreatment, or neglect and a relatively new

obligation to report reasonable suspicions of a crime against a

participant. Sometimes they can be held liable if they don’t and

the abuse, mistreatment, or neglect is discovered.

• As the direct care provider, you are not expected to investigate

and draw the conclusion that abuse, neglect, or misappropriation

has happened.

• A Direct Care Provider’s only responsibility is to report any actual,

alleged, or suspected incidents to the appropriate persons and

explain their reason for concern.

• Sometimes explanation for reason of concern is as simple as observing

behaviors that are not normal or that seem worrisome.

• Knowing this makes the responsibility less intimidating.

• Once the report has been made, it is then the investigator’s

responsibility to investigate and make the determination whether

misconduct occurred and what punishment, if any, is imposed.

Disability Awareness Best Practices

Talk directly to the person who has the disability, nothis or her companion, aid or interpreter.

• Ask the person what their communication preference is.

• When talking to a person with disabilities, you should first say “hello” then introduce yourself by using your name and position...

• If possible, put yourself at eye-level with the person you are speaking with. Listen attentively and be patient. Ask a person about his or her disability and the capabilities or limitations they may have.

• Use People-First Language

• Choose your words carefully

• Don’t use the medical diagnosis as a label for the person.

• Emphasize capabilities, not restrictions.

• Avoid the use of words that can create a negative perception.

• Refrain from patronizing, or talking down, to a person with disabilities. The level of challenge a person with disabilities may encounter has no bearing on their intelligence.

• Before stepping in to help someone with a disability

always as, “Can I help you with that?” and be

respectful of their answer

Courses Completed

Once training is complete send form with your name, email. Message section type all training you completed and the date.

Example:  I Jane Doe completed Fraud Waste and Abuse, Cultural Competency on 4/1/2021.  List all training completed. Click to submit form


Annual Training 

https://courses.mihealth.org/MIHealthLink/

Submit certificate of completion to [email protected]

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