SESSIONS
Wednesday, May 14th
Fully Virtual
8:30 am - 9:30 am
1a. Licensing Surveys and Rules: How to Prepare for and What to Expect During a Survey
Session Description:
By understanding the knowledge and tools surveyors bring into the agency for a survey or investigation, keeping up to date with the latest regulations, and placing QAPI into your agency's compliance toolbox, a home and community support service agency (HCSSA) can address deficient practices before a surveyor identifies them onsite. The goal is for agencies to significantly improve the likelihood of a smooth and successful licensing/certification survey.  This session will guide home care professionals through the critical aspects of preparing for a licensing survey, what to expect during the survey, and the latest regulatory updates that may affect agency operations. The key takeaway is that preparation, ongoing compliance efforts with plans of corrective action, and understanding the survey process are essential for achieving and maintaining licensing success.  The focus will be on key surveyor practices, updates in requirements (including the upcoming OASIS rule), and strategies for ensuring compliance.
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Speaker: Rosalind J. Nelson-Gamblin, Consultant, RJNG Health Care Consulting, LLC
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Continuing Education: 1.0 clock hours continuing education for Administrators/Alternates; 1.0 contact hours continuing nursing education for Nurses
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9:45 am - 10:45 am
2a. How to Communicate with Surveyors and Respond to Survey Deficiencies
Session Description:
Join us in this engaging session that will help HCSSA providers navigate the survey process by understanding how to handle deficiencies, how to communicate effectively with surveyors, and what steps to take when you disagree with findings. The session will also address how to create and document an effective Plan of Correction (PoC) and the best strategies for handling difficult situations. Effective communication with surveyors and a proactive approach to addressing deficiencies can lead to better outcomes during the survey process. By understanding the different types of deficiencies, how to respond professionally, and how to create an effective Plan of Correction, HCSSA providers can navigate the survey process with confidence.
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Speaker: Colleen Woods, MSNED, RN, Chief Consulting Officer, Lead Educator, JCC Texas
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Continuing Education: 1.0 clock hours continuing education for Administrators/Alternates; 1.0 contact hours continuing nursing education for Nurses
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11:00 am - 12:00 pm
3a. What’s Next? Understanding Enforcement Actions & Penalties and Protecting Your Agency
Session Description:
This session will help all healthcare agencies understand the enforcement actions and penalties they might face following deficiencies, including the appeal process, the role of the National Practitioner Data Bank (NPDB), and strategies for protecting the agency’s reputation and operations. It will also cover how to respond to enforcement actions and how to address issues like self-reporting complaints and other serious matters. If you are ever faced with enforcement actions, respond proactively, be thorough in documentation, and consult with legal professionals to ensure the best possible outcome. By staying informed about the latest proper procedures, you can help ensure that your agency remains compliant and minimize the risk of reputational damage.
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Speaker: Troy Brooks, Of Counsel, Degan, Blanchard & Nash
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Continuing Education: 1.0 clock hours continuing education for Administrators/Alternates​
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1:00pm - 2:30pm CONCURRENT TRACKS
Medicare Track
4a. Navigating Medicare Advantage: Mastering Third-Party Medical Reviews in Home Health Care
Session Description:
Gain critical insights into Medicare Advantage and enhance your agency’s proficiency with third-party medical reviews. This session will explore key strategies for home health agencies to successfully manage, prepare for, and respond to medical necessity audits and claims reviews conducted by third-party entities. Learn practical techniques for documentation excellence, understand common pitfalls, and discover best practices to ensure compliance, streamline reimbursement processes, and safeguard your agency's financial health.
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Speaker: J’non Griffin, RN MHA, HCS-D, HCS-O, HCS-H, HCS-C, COS-C, Strategic Relations & Education, ACHC
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates; 1.5 contact hours continuing nursing education for Nurses
Medicaid Track
4b. All Things EVV
Session Description:
Don’t miss this information-filled session from HHSC on “all things EVV.” The latest on the following will be shared:
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Alternative Device Reduction
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EVV Compliance Reviews
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EVV Usage Reviews
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EVV Landline Phone Verification Review
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EVV Resources
There will also be a Q&A session that will allow attendees to engage and interact with the speakers to ensure all of your EVV questions are answered.
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Speaker: James Brady, EVV Manager; Timothy Reedy, EVV Training Specialist; Tricia Barrett, Training Specialist, HHSC
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates
HHSC Contracting Track
4c. Understanding Contract Monitoring
Session Description:
Basic overview of the contract monitoring process. From A to Z:
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General background information on contract monitoring process
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What providers can expect during the monitoring process
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Required Timeframes for monitoring
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How contract monitoring works
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Which programs this impacts
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Speaker: Rosalind J. Nelson-Gamblin, Consultant, RJNG Health Care Consulting, LLC
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates
Hospice Track
4d. A to Z of Hospice Contracting
Session Description:
Contracting is a formal process and involves agreement and compliance with the agreement. Join Marlon Ballard, HHSC, Manager, as he walks you through the A to Z of Hospice Contracting with HHSC. Providers should understand that reading and comprehending a contract thoroughly is crucial. Providers should understand all obligations including any important deadlines and milestones for tasks or payments. Ensure that all of your questions are answered and walk away ready fully compliant with Hospice contracting.
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Speaker: Marlon Ballard, HHSC, Manager, Hospice Consulting
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates
2:45pm - 4:15pm CONCURRENT TRACKS
Medicare Track
5a. Coming From Every Angle: Dealing with Home Health Medical Review
Session Description: Home Health is under a high level of medical review scrutiny, resulting in increased requests for patient charts to be reviewed. It seems the review contractor list keeps growing: Targeted Probe and Educate, SMRC, RAC or UPIC audits. All home health agencies must be prepared to respond to ADRs with documentation that supports ongoing medical necessity and clearly meets regulatory guidelines, including homebound status. This session will provide guidance and examples to ensure your agency is prepared to respond to any medical review request and best practices for avoiding denials.
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Speaker: Melinda A. Gaboury, COS-C, Chief Executive Officer, Healthcare Provider Solutions, Inc
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates; 1.5 contact hours continuing nursing education for Nurses
Medicaid Track
5b. 3rd party MCO Medical Reviews Process
Session Description:
Join MCO representative as they review the full MCO medical review process. You don’t want to miss out on the most up to date information straight from the MCOs themselves. From process to enforcement to how compliance is tracked and how each health plan roll it out, you will be able to hear it all? There will also be a discussion on the Special Investigative Units (SIU) and what this means and how providers are chosen for this type of audit.​
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Speaker: MCO Representatives from Community Health Choice, Wellpoint, Texas Children’s Health Plan, Molina, United Health Care
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates
HHSC Contracting Track
5c. Understanding Enhanced Contract Monitoring
Session Description:
Building on a foundational understanding of contract monitoring, this presentation introduces agencies to the next level: Enhanced Contract Monitoring. Join HHSC representatives as they provide valuable insight into how enhanced monitoring is implemented, the criteria used to identify providers for this level of oversight, and the responsibilities agencies hold throughout the process.​
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Speaker: Michael Grisham,
Director, Contract Management Support, Procurement and Contracting Services, HHSC; Laci Edwards, Community Care Services Contracts, Contract Administration Manger Region 02/09, Certified Texas Contract Manager (CTCM), HHSC and Misti Hudnall, Senior Advisor Community Care Services Contracts, HHSC
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates
Hospice Track
5d. Texas High Risk Hospices Under PPEO: Preparing for Audit
Session Description: With 48% of Texas hospices who were selected for Provisional Period of Enhanced Oversight (PPEO) ADRs falling into the major risk category for subsequent audit probes, it is critical for hospices to understand the medical review audit and appeals process, top denial risks and regulatory requirements to succeed under medical review and avoid subsequent audits. This session will address the various types of hospice medical review audits, top denial reasons, discuss the appeals process, and provide guidance, tips and examples to ensure your agency is prepared to respond to ADRs for positive outcomes. ​
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Speaker: Victoria Barron, MBA, BSN, RN, COS-C, Clinical Consultant, Healthcare Provider Solutions Inc
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Continuing Education: 1.5 clock hours continuing education for Administrators/Alternates; 1.5 contact hours continuing nursing education for Nurses