Florida registries meet new requirements
Because long-term care insurance policies in Florida must provide the option of using nurse registries, the registries must meet stringent payer requirements. (For more information about the Florida law, see story, p. 27.) Capitated Health Care Services (CHCS), a home care network manager in Sunrise, FL, uses state guidelines to evaluate potential providers, says Susan Zimmerman, RN, CCN, chief operating officer.
Some of what CHCS examines include the following:
• license to provide care;
• history of business, such as how long they have been in operation;
• forms and paperwork;
• proof of customer satisfaction, such as surveys;
• quality management programs;
• hiring and employee screening policies, such as background checks;
• employee orientation programs;
• rate structures and how employees are paid;
• liability insurance;
• bonding;
• worker’s compensation coverage;
• references from clients;
• visit scheduling system;
• telephone systems;
• capability to provide 24-hour care.
CHCS approaches providers in the same way, whether the provider is a Medicare-licensed agency or a registry, Zimmerman says. "From our standpoint, there isn’t any deviation in the quality of management system."
When CHCS receives a client, it sends a nurse assessor to the client’s home. The nurse obtains the proper documentation for the client and develops a care plan. If the referral goes to a registry, for example, the rate for care is negotiated with the registry up front, and the registry is given pre-authorization for a set number of hours of service on set days per the client’s request or needs.
"The registries are distinctly told what types of service they are going to need to provide," Zimmerman explains. "We also give them a calendar with pre-authorized visits. We tell them what time they are supposed to be there. If they deviate from that schedule, they have to let us know."
CHCS then closely monitors the client care. "We do ongoing management of the clients telephonically, and check with them on a weekly basis while they are receiving care," Zimmerman says. "We get copies of signed time slips from the client to make sure that someone was there. We do site reviews on a quarterly basis and clinical record review on a quarterly basis." CHCS also does on-site evaluations.
Every CHCS client has a case manager that oversees his or her care, says Zimmerman. If clients have a problem with their providers, they are told to call the network case manager.
"If they have any problem with the punctuality, the quality, the way someone looks, the way they smell, what they’ve done, we direct them to call us immediately," says Zimmerman.
Registries have proven to be a cost-effective and efficient option for long-term care, she says. "We are still going to do the same supervision that we’ve done [with other providers], and we haven’t noticed any deviation in the outcomes."
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