Management of Human Resources s1

Table of Contents Management of Human Resources

POLICIES

Classification of Employees...... 7.1 Attendance and Reporting...... 7.2 Sexual and Other Harassment...... 7.3 Disciplinary Action/Grievance Procedure...... 7.4 Non-Compete Agreements...... 7.5 Employee Recruitment Process ...... 7.6 Employment...... 7.7 License, Registration or Certification Requirements...... 7.8 Personnel Records...... 7.9 Contractual Staff ...... 7.10 Supervision of Therapy and Social Work Assistants...... 7.11 Administrator Training...... 7.12 Blank ...... 7.13 Blank ...... 7.14 Blank ...... 7.15 Blank ...... 7.16 Employee Orientation...... 7.17 In-service Education/On-going Training...... 7.18 Staff Competency Program...... 7.19 Job Description...... 7.20 Performance Appraisals/Evaluations...... 7.21 Roles and Responsibilities Related to Safety...... 7.22 Driver License/Auto Insurance...... 7.23

FORMS/ATTACHMENTS

Salary Rates...... 7.1A Orientation Checklist...... 7.17A Initial Competency Checklist RN/LPN/LVN...... 7.19A Initial Competency Checklist Physical Therapist...... 7.19B Initial Competency Checklist Physical Therapy Assistant...... 7.19C Initial Competency Checklist Speech Language Pathologist...... 7.19D Initial Competency Checklist Medical Social Worker ...... 7.19E Initial Competency Checklist Occupational Therapist...... 7.19F Initial Competency Checklist Occupational Therapy Assistant...... 7.19G Blank ...... 7.19H Blank ...... 7.19I Annual Competency Assessment Skilled Nurse...... 7.19J Annual Competency Assessment Physical Therapist/ Physical Therapy Assistant ...... 7.19K Annual Competency Assessment Speech Language Pathologist ...... 7.19L

Professional Pediatric Home Care December 2012 Contents - Chapter 7 Annual Competency Assessment Medical Social Worker...... 7.19M Annual Competency Assessment Occupational Therapist/ Occupational Therapy Assistant...... 7.19N Blank ...... 7.19O Job Description Administrator ...... 7.20A Job Description Director of Clinical Services...... 7.20B Job Description Controller...... 7.20C Job Description Business Development Manager...... 7.20D Job Description Director of Therapy...... 7.20E Job Description Business Office Manager……………………………………………………. 7.20F Job Description Nursing Supervisor...... 7.20G Job Description Registered Nurse (RN) ...... 7.20H Job Description Licensed Practical (Vocational) Nurse (LPN/LVN) ...... 7.20I Job Description Medical Social Worker (MSW) ...... 7.20J Job Description Physical Therapist (PT) ...... 7.20K Job Description Physical Therapy Assistant (PTA) ...... 7.20L Job Description Occupational Therapist (OT) ...... 7.20M Job Description Certified Occupational Therapy Assistant (COTA) ...... 7.20N Job Description Speech Language Pathologist (SLP) ...... 7.20O Job Description Intake Coordinator…………………………………………………………….7.20P Job Description Therapy Coordinator...... 7.20Q Job Description Medical Records Support Specialist...... 7.20R Job Description Medical Administrative Assistant ………………………………………….. 7.20S Job Description Billing Authorization Manager...... 7.20T Job Description Payroll/HR Assistant...... 7.20U Job Description Medical Billing Manager……………………………………………… 7.20V Job Description Training and Documentation Manager……………………………………..7.20W Performance Appraisal/Evaluation Administrator...... 7.21A Performance Appraisal/Evaluation Director of Nursing...... 7.21B Performance Appraisal/Controller...... 7.21C Performance Appraisal/Evaluation Business Development Manager...... 7.21D Performance Appraisal/Evaluation Director of Therapy...... 7.21E Performance Appraisal/Evaluation Business Office Manager...... 7.21F Performance Appraisal/Evaluation Nursing Supervisor...... 7.21G Performance Appraisal/Evaluation Registered Nurse (RN) ...... 7.21H Performance Appraisal/Evaluation Licensed Practical Nurse (LPN) ...... 7.21I Performance Appraisal/Evaluation Medical Social Worker (MSW) ...... 7.21J Performance Appraisal/Evaluation Physical Therapist (PT) ...... 7.21K Performance Appraisal/Evaluation Physical Therapy Assistant (PTA) ...... 7.21L Performance Appraisal/Evaluation Occupational Therapist (OT) ...... 7.21M Performance Appraisal/Evaluation Certified Occupational Therapy Assistant (COTA) .7.21N Performance Appraisal/Evaluation Speech Language Pathologist (SLP) ...... 7.21O Performance Appraisal/Evaluation Intake Coordinator...... 7.21P Performance Appraisal/Evaluation Therapy Coordinator...... 7.21Q Performance Appraisal/Evaluation Medical Records Support Specialist………………… 7.21R Performance Appraisal/Evaluation Administrative Support Specialist…………………… 7.21S Performance Appraisal/Evaluation Billing Authorization Manager...... 7.21T

Professional Pediatric Home Care December 2012 Contents - Chapter 8 Performance Appraisal/Evaluation Payroll/HR Assistant...... 7.21U Performance Appraisal/Evaluation Medical Billing Manager...... 7.21V Performance Appraisal/Evaluation Training and Documentation Manager...... 7.21W

Professional Pediatric Home Care December 2012 Contents - Chapter 8 Professional Pediatric Home Care December 2012 Contents - Chapter 8 ACHC Standard HH4-2I

Classification of Employees

______POLICY All employees will be classified as exempt or nonexempt based upon their job categories and duties performed.

______PURPOSE To define exempt and nonexempt personnel and ensure that employees receive fair and equitable pay for their positions.

______REFERENCE Fair Labor Standards Act, Paragraph 213. (a)(15)

______PROCEDURE 1. Exempt employees include executive, administrative and professional salaried employees whose job duties and rate of pay permit them to be “exempt” from the provisions of the Federal Wage-Hour Law.  Exempt employees are not eligible for overtime pay.

2. Nonexempt employees include both hourly paid employees whose job duties and rate of pay make them subject to the overtime provision of the Fair Labor Standards Act or Federal Wage-Hour Law and hourly paid employees whose job duties exclude them from the overtime provision of the Fair Labor Standards Act.  Nonexempt employees, who are not excluded from the overtime provision of the Fair Labor Standards Act, are paid at the rate of time and one-half their regular hourly rate of pay for each hour worked over 40 hours in a one week (7 day) period.  Nonexempt employees, who are excluded from the overtime provision of the Fair Labor Standards Act, are paid at regular hourly rate of pay for all hours worked.

3. The Agency has established written salary scales for each position classification, as well as overtime, on-call and holiday pay rates. Employee salaries are individualized and are based upon their experience and education for a particular position.  Employees are not to share salary information with other employees.  There may be times when staff will be asked to work over time. Non-exempt employees will receive overtime pay in accordance with federal and state wage and hour laws. All overtime must be approved and authorized by the Administrator.  The maximum number of hours a nurse (RN/LPN) may work in a 24 hour period is 16 hours. There must be a minimum of 8 hours away from patient care.

Professional Pediatric Home Care December 2012 7.1 ACHC Standard HH4-2I

4. In addition to being classified as exempt or non-exempt, employees may be classified as regular full-time, regular part-time, per-visit or temporary employees:  Regular full-time – an employee that is regularly scheduled to work at least 36 hours a week. Full-time employees are eligible for benefits as described in the employee handbook and policies.  Regular part-time - an employee that is regularly scheduled to work at least 20 hours but fewer than 36 hours per week. Part-time employees are not eligible for Company paid benefits with the exception of the 401(k) plan.  Per-visit – an employee that is paid per visit to a patient, based on a pre-determined compensation schedule. Per visit employees are generally not eligible for benefits.  Temporary – an employee who works for the Agency on a temporary basis for a specified project or time frame, with a predetermined start and end date of employment. Temporary employees are not eligible for benefits.

Professional Pediatric Home Care December 2012 7.1 ACHC Standard HH4-2I

SALARY RATES

Pay ranges were determined by comparing rates with other Agencies in our geographic location.

RN HOURLY...... $24.00 - 27.50 LPN HOURLY...... $19.25 PT PER VISIT ...... $ 65 - $ 75.00 OT PER VISIT ...... $ 65 - $ 75.00 ST PER VISIT ...... $ 65 - $ 75.00 SW PER VISIT ...... $ 60.00

On-Call Pay

The agency Administrator and Nursing Director will share on call time according to a mutually agreed upon schedule. Time off will be given to compensate for time taken to take care of any call requests.

Holiday Pay

Regular full-time employees will be paid for recognized holiday time off. If an eligible nonexempt employee works on a recognized holiday, the employee will be paid one and one half times their base pay rate for working on the holiday. Eligible employees are entitled to the following paid holidays: New Year’s Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day after Thanksgiving, Christmas Eve and Christmas Day.

Overtime Pay

There may be times when staff will be asked to work overtime. Non-exempt employees will receive overtime pay in accordance with federal and state wage and hour laws. All overtime must be approved and authorized by a supervisor.

The maximum number of hours a nurse (RN/LPN) may work in a 24 hour period is 16 hours. There must be a minimum of 8 hours away from patient care.

Professional Pediatric Home Care December 2012 7.1A Attendance and Reporting

______POLICY Regular attendance and punctuality at scheduled work times will be expected of all employees.

Attendance and punctuality will be considered when the Agency reviews recommendations for promotions, salary increases and transfers.

______PURPOSE To outline attendance/punctuality requirements for employees of the Agency.

______PROCEDURE 1. Employees will be expected to report at the scheduled work time, including returning from breaks and lunch. Any employee not ready to begin work at the scheduled times will be considered tardy.

2. If an employee expects to be delayed for any reason, he/she will notify and inform his/her supervisor of the reason for late arrival and the expected arrival time.

3. An absence is the failure to report to work at the scheduled time and is defined as lost time (partial or full day) due to illness, injury, personal business or other reasons for which the Agency is not responsible.

4. Employees will notify their supervisor as soon as the employee is aware of the need to be absent, but no later than one (1) hour before the scheduled starting time.  The expected duration of the absence should be communicated to the supervisor in advance, if possible.

5. In the event an emergency or hospitalization occurs due to sudden illness or accident, the immediate supervisor will be notified by the employee’s designated emergency contact as soon as possible.  A doctor’s statement may be required and should be sent to the Agency within three (3) working days.  If the immediate supervisor is not available, the next level of supervision should be notified.

6. A doctor’s statement may be required for any illness. The Agency may request a corroborating statement from a consulting physician. The doctor’s statement will include: Professional Pediatric Home Care December 2012 7.2  The nature of the illness.  The expected duration of the illness.  The anticipated return date.

7. A doctor’s release stating the date an employee may resume normal duties at work may be required at the time an employee returns from an absence and should be submitted to the Agency at the time of return.

8. When determining whether an employee should be disciplined for excessive tardiness or absenteeism, the supervisor will apply sound judgment based on knowledge of the circumstances.

9. Any disciplinary action taken will be consistently applied in like situations.

Professional Pediatric Home Care December 2012 7.2 Sexual and Other Harassment

______POLICY The Agency will not tolerate conduct by any employee who harasses, disrupts or interferes with another employee’s work or creates an offensive or hostile work environment. While all forms of harassment are prohibited, the Agency emphasizes that sexual harassment is specifically prohibited.

______PURPOSE To ensure an effective means by which an employee who believes that he/she has been subjected to harassment in the workplace can report the incident.

______REFERENCE Title VI of the 1964 Civil Rights Act ______PROCEDURE 1. Any employee who believes he/she has been subjected to sexual or racial harassment in the workplace by a manager, coworker or patient should report the alleged incident to the Administrator as soon as possible.

2. If the employee feels uncomfortable discussing the incident with the Administrator, or if the incident relates to or involves the Administrator and/or Supervisor will be notified.

3. Any employee who violates the policy against sexual harassment, or encourages another to violate the policy, will be subjected to appropriate disciplinary action depending on the severity and type of violating behavior, up to and including discharge.

4. Sexual harassment is a form of sex discrimination and is an unlawful employment practice under Title VI of the 1964 Civil Rights Act. Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct constitutes sexual harassment when:  They are part of a supervisor’s or manager’s decisions to hire, fire, promote or transfer.  They are used to make other employment decisions, e.g., pay.  They interfere with the employee’s work performance.  They create an intimidating, hostile or offensive work environment.

5. Sexual harassment is defined as deliberate or repeated behavior of a sexual nature which is unwelcome. It can include verbal and/or nonverbal behavior.

Professional Pediatric Home Care December 2012 7.3 ACHC Standard HH4-2I, HH4-9A.01

Disciplinary Action/Grievance Procedure

______POLICY The Agency communicates clear expectations with regards to job performance, work behavior, standards of conduct, disciplinary action, and employee grievance.

Employees also have the right to terminate their employment with the Agency.

______PURPOSE To administer fair and reasonable methods of disciplinary action for those employees or contract personnel whose job performance or behavior does not meet the standards the Agency as outlined elsewhere in this policy.

______POLICY

DISCIPLINARY ACTION

When a staff member’s job performance or work behavior does not meet those standards for continued employment and/or results in negative patient outcomes, it is the policy of the Agency to initiate disciplinary action for corrective purposes in the following manner:  Verbal Reprimand: Considered to be a notice to the employee that the job performance or work behavior does not meet standards of employment.  Written Reprimand: Considered to be further notice to the employee of undesirable work behavior or unacceptable job performance, submitted in writing and placed in the personnel file for permanent record.  Suspension without Pay: Considered to be the final notice to the employee that undesirable work behavior or unacceptable job performance must be corrected at once.  Discharge/Termination: Considered to be the most extreme form of disciplinary action and final step in this process. This will occur when all previous steps have been followed or in the event that immediate discharge is considered to be justifiable by the Supervisor, Director of Nursing and Administrator.  Furthermore, it is the policy of the Agency that all employees shall have the right to initiate an internal grievance procedure in connection with any aspect of this policy.

STANDARDS OF CONDUCT

The following standards of conduct are prescribed to assure continuation of employment. Employees are at all times expected to:  Give primary consideration to the welfare of patients, employees and visitors.  Respect established authority.  Use facility equipment and supplies judiciously and with extreme care.

Professional Pediatric Home Care December 2012 7.4 ACHC Standard HH4-2I, HH4-9A.01

 Perform all duties and responsibilities in an acceptable manner, according to applicable standards, laws and regulations.  Be honest; seek help in resolving problems.  Present a neat and clean personal appearance.  Comply with Agency policies and procedures.  Conduct themselves as responsible members of the staff and as good citizens.

INITIATION OF DISCIPLINARY ACTION

When an employee's job performance or work behavior ceases to meet acceptable standards for continued employment, disciplinary action procedures are initiated by persons in authority. Those persons having this authority are as follows:  The employee's immediate supervisor.  The Director of Nursing.  The Administrator.  A supervisor or department manager, not directly associated with the employee, in the case of an event occurring while the employee's supervisor and/or department manager are not present.  Verbal Reprimand: The first step in the process is the verbal reprimand issued to the employee as an initial warning. Although this reprimand is not a formal disciplinary action, the Director of Nursing is made aware of it for future reference.  Written Reprimand: The next step in the process is the written reprimand issued to the employee as the second warning. This reprimand is presented to the employee in writing and is documented on a Disciplinary Action Form requiring the signature of the counselor and the employee. o The employee is asked to sign this document not as an admission of guilt, but to acknowledge that the counseling did occur. o The document is placed in the employee's personnel file as a part of the permanent employment record regardless of signature. Failure to sign the form must be documented on the Disciplinary Action Form.

 Suspension without Pay: The next step in the process is suspension without pay issued to the employee as the third and final warning. This action is presented to the employee in writing and is documented on a Disciplinary Action Form requiring the signature of the counselor and the employee. o The employee is asked to sign this document not as an admission of guilt, but to acknowledge that the event did occur. o This document is placed in the employee's personnel file as a part of the permanent employment record regardless of signature. o The employee will not be allowed to return to work until the suspension period has expired and the appropriate corrective action has been completed.

 Discharge/Termination: The final step in the process is discharge/termination. At this time, the employment status is terminated and termination documents are processed. o When the decision is made to enter into this step of the process, it has been fully determined through previous steps that the employee does not intend to correct the

Professional Pediatric Home Care December 2012 7.4 ACHC Standard HH4-2I, HH4-9A.01

undesirable work behavior or unacceptable job performance and thus fails to meet those standards required for continued employment. o The action is documented on the Disciplinary Action Form requiring the signature of the counselor and the employee. o The employee is asked to sign the document not as a direct admission of guilt, but to acknowledge that the event did occur.

 Immediate Suspension: Automatic suspension occurs when it is determined by those persons having authority that the employee has: o Violated Agency and/or department policy to the extent that damage is done, or the results and consequences of the action will be severely detrimental to the Agency or to patients. o Exhibited extremely undesirable work behavior and/or job performance or neglect of job performance. o Substantially violated those standards of conduct set forth in the Agency’s policies to the extent that damage is done, or the results and consequences of the violation will be severely detrimental to the Agency, the department, and/or patients. o Other undesirable actions as deemed sufficient to justify automatic and immediate discharge.

 Those persons having the authority to execute immediate suspension are as follows: o The employee's immediate supervisor, upon the direction and approval of the Director of Nursing. o The Director of Nursing. o The Administrator. o A supervisor and/or department manager not in a regular or routine working relationship with the employee, if the undesirable action occurs at a time when the employee's supervisor and/or department manager are not present.

GENERAL PROCEDURES INVOLVING DISCIPLINARY ACTION

 The employee, at all times, shall have the right to initiate the internal grievance procedure for matters related to the disciplinary action process. The employee may obtain information regarding the grievance from the Administrator/Director of Nursing.  The disciplinary action process is to be administered fairly and consistently to all employees at all times and in a manner consistent with policy, rules and regulations to assure equal treatment to all employees.  Employees shall be informed of their status throughout the disciplinary action process of the following items: o What he/she can expect to occur next if the problem is not corrected. o What actions he/she can take to correct the problem. o What specifically leads to the disciplinary action. o Specifically, what is necessary for the employee to meet standards for continued employment. o What is a reasonable period of time in which corrective action is to occur.

Professional Pediatric Home Care December 2012 7.4 ACHC Standard HH4-2I, HH4-9A.01

PROCEDURE - EMPLOYEE GRIEVANCE REPORTING METHODS

 Problems arise in any group of people working together. It is important to all that these problems be solved as quickly and as fairly as possible so that small problems do not grow out of proportion. Occasionally, however, it may be necessary to investigate certain problems in greater detail. The grievance procedure enables the employee to have a fair review of any work-related controversy, dispute or misunderstanding.  If the employee feels there is a valid grievance, the following procedure is used: o Step One: An employee may submit, in writing or orally, the problem to his/her immediate supervisor or department manager within three (3) days after the problem becomes known to the employee. The supervisor or department manager will attempt to resolve the employee's grievance during the initial meeting. If unable to reach a mutually agreed upon solution, the supervisor or department manager will investigate the situation further and within three (3) working days, meet with the employee with a proposed solution to the grievance. If the employee is still not satisfied, then he/she may request a Step Two meeting. o Step Two: If the employee is not satisfied in Step One, he/she must submit in writing within five (5) working days the problem or grievance. Human Resources will investigate the problem with all involved parties and schedule a meeting with the employee and the supervisor or department manager. The employee may elect to have a fellow employee accompany him/her to this meeting to assist in the presentation of the problem. A concerted effort will be made at this meeting to resolve the problems. o Step Three: If the employee does not feel there has been a satisfactory resolution reached by speaking with the supervisor, he/she may submit a written grievance/complaint to the Director of Nursing/Administrator. The Director of Nursing/Administrator will review the complaint/grievance, if necessary review the information with the employee and/or supervisor, and within five (5) working days of completing the review, render a decision about the grievance/complaint. The employee and the supervisor will be notified of the decision. o Step Four: if the employee is not satisfied with the decision or feels the grievance/ concern has not been resolved to his/her satisfaction, the employee has the option of requesting that the grievance/complaint be forwarded to the Governing Body. The Governing Body will review the grievance/complaint within ten (10) working days of receiving the complaint/grievance and render a decision. The decision will be delivered to the employee in writing. The decision of the Governing Body is final and binding.

 Employees who are discharged for cause may appeal that decision by using the grievance procedure. However, discharged employees shall appeal as in Step One and the appeal must be in writing. In order to be considered, any discharge appeal must be received within seven (7) working days of the discharge.

Professional Pediatric Home Care December 2012 7.4 Non-Compete Agreements

______POLICY The Agency shall not prevent an employee from terminating the employment relationship and commencing employment at another home care agency.

______PURPOSE To establish restrictions on non-compete agreements.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

Colorado Revised Statutes (C.R.S.) Section 8-2-113

______PROCEDURE 1. The Agency shall not coerce, threaten, or use any means of intimidation to prevent an employee from terminating the employment relationship and commencing employment at another home care agency.

2. Non-compete clauses, agreements or contracts shall only be enforceable in accordance with Section 8-2-113, C.R.S.

Professional Pediatric Home Care December 2012 7.5 ACHC Standard HH4-2I

Employee Recruitment Process

______POLICY The Agency is an Equal Opportunity Employer which strives to employ the most qualified individuals for all positions and to ensure the adequate number of appropriate staff.

______PURPOSE To establish guidelines for the recruitment and hiring processes.

______PROCEDURE 1. Each position will have a job description.

2. Established procedures for application and interviewing process will be followed.  Reference information or work history will be obtained on all applicants. A minimum of one reference is required for new employees.  Equal employment opportunities will be available to all candidates.  Education, training, licensure, competency and other required credentials will be verified, as able.

3. Employment opportunities will be posted internally.

4. Internal advancement in employment status will be on eligibility, position specific criteria and established procedures.

5. Compensation packages will be reviewed on a periodic basis, giving consideration to changes in job function according to industry norms.

6. The Agency will evaluate recruiting, hiring and retention of personnel at least annually and more often if needed.

7. The Agency will use reasonable methods to recruit personnel, including but not limited to newspaper advertising, advertising in professional journals, online or by attendance at job fairs. The Agency may, on occasion use the services of temporary employment agencies or recruiters.

Professional Pediatric Home Care December 2012 7.6 ACHC Standard HH4-2I

Employment

______POLICY The Agency provides equal employment opportunities to all employees and applicants regardless of race, color, creed, sex, national origin, age, qualified handicap, sexual orientation, marital status or veteran status.

______PURPOSE To assure that Equal Employment Opportunity Commission (EEOC) policies are followed by the Agency.

______PROCEDURE 1. The Agency will employ only individuals who are U.S. citizens or who meet the requirements of the Immigration Reform and Control Act of 1986 and other applicable federal laws. This includes complying with state and federal legislation regarding age limitations.

2. The Agency will employ or contract with only individuals who meet the licensure or certification requirements for the particular professional position. The individual must be in good standing there under.

3. The Agency complies with the American with Disabilities Act of 1994.

Professional Pediatric Home Care December 2012 7.7 ACHC Standard HH4-2F.01, HH4-4A

License, Registration or Certification Requirements

______POLICY The employee will be responsible for maintaining a current license for any position requiring such.

______PURPOSE To provide a mechanism whereby the Agency assures that all personnel license(s) or certification(s) are kept current and are documented in Agency records.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______PROCEDURE 1. The supervisor will be provided with current licensure and/or certification information, if applicable.

2. When current licensure, certification and /or registration are required by law and/or regulation to practice a profession, the Agency verifies such credentials with the primary source at time of hire, annually and prior to or upon expiration of credentials. Primary source verification will occur through the applicable state board of practice for: registered nurses, licensed practical nurses, physical therapist, licensed physical therapy assistant, occupational therapist, certified occupational therapy assistant, speech language therapist and licensed clinical social worker, if required by state law.

3. Primary source verification of current licensure, registration and/or certification may be performed via secure electronic access or by telephone. All such verification will be documented.

4. If an employee allows professional license or certification to expire, the employee will not be permitted to work until current license or certification is obtained, if license or certification is required for the position.

5. Each employee and contracted staff shall possess the education and experience to provide services in the homes of patients in accordance with agency policy, state practice acts and professional standards of practice as set forth in Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies.

Professional Pediatric Home Care December 2012 7.8 ACHC Standard HH4-2F.01, HH4-4A

6. All licensed, registered or certified healthcare providers shall, at a minimum, meet the following requirements:  Be qualified as a physician, pharmacist, physician assistant, nurse practitioner, cli nical social worker, social worker, physical therapist, occupational therapist, respirato ry therapist, registered nurse, licensed practical nurse, or other provider licensed, regi stered or certified by the Colorado Department of Regulatory Agencies (DORA).  Meet the requirements for license, certification or registration set forth by DORA.

8. Staff not regulated under DORA shall, at a minimum, meet the following requirements:  A speech-language pathologist shall: o Possess a current certificate of clinical competence in speech pathology or audiology granted by the American Speech-Language-Hearing Association, or o Meet the educational requirements for certification and be in the process of accumulating the supervised experience required for certification.  An occupational therapy assistant shall, at a minimum: o Possess a current certification from the National Board for Certification of Occupational Therapy (NBOT).  A physical therapist assistant shall: o Have completed a physical therapist assistant program accredited by the commission on accreditation in physical therapy or any comparable successor entity; o Be registered, licensed or certified as a physical therapist assistant in another state; or o Be otherwise qualified to take the physical therapy examination.

Professional Pediatric Home Care December 2012 7.8 ACHC Standard HH4-1A.01, HH4-1A.02, HH4-2H.01, HH4-3A.01

Personnel Records

______POLICY Personnel files will be established and maintained for all staff. All information will be considered confidential and will be made available to authorized management personnel only.

______PURPOSE To maintain personnel files on current and former employees.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______PROCEDURE 1. The personnel record for an employee will include, but not be limited to, the following:  Application.  Dated and signed withholding statements.  Wage ranges for this position and current pay for this employee.  Explanation of benefits.  Dates of employment and separation from the agency.  Current employee demographic information.  Valid drivers’ license.  Appropriate proof of automobile insurance.  Reason for separation from the agency.  Individual job qualifications (application/resume).  Signed copy of job description.  Documentation of receipt of the Employee Handbook.  Verification of education/training (diploma, transcripts). o Certification for specialty areas of practice as applicable.  Statement of formal training for non-professionals.  Applicant to provide at least 3 references and the Agency will verify at least 2.  Pre-employment interview(s).  Evidence of receipt of ID badge.  Current license, registration or certification as applicable.  Copy of license, registration or certification confirmation through Colorado Department of Regulatory Agencies; or for staff not regulated under DORA: o A speech-language pathologist shall provide documentation of: - a current certificate of clinical competence in speech pathology or audiology granted by the American Speech-Language-Hearing Association, or

Professional Pediatric Home Care December 2012 7.9 ACHC Standard HH4-1A.01, HH4-1A.02, HH4-2H.01, HH4-3A.01

- having met the educational requirements for certification and being in the process of accumulating the supervised experience required for certification. o An occupational therapy assistant shall provide documentation of, at a minimum: - a current certification from the National Board for Certification of Occupational Therapy (NBOT). o A physical therapist assistant shall provide documentation of: - completion of a physical therapist assistant program accredited by the commission on accreditation in physical therapy or any comparable successor entity; - registration, license or certificate as a physical therapist assistant in another state; or - qualifications necessary to take the physical therapy examination.  Validation of completion of the orientation process with completed orientation checklist.  Validation of competency skills testing for all patient care staff. o Time of hire through orientation period. o Annual.  Validation of performance evaluation at completion of 90 day probationary period.  Documentation of supervision.  Validation of annual performance evaluation. o Evaluation will include joint home visit with supervisor/peer for all patient care staff.  Validation of malpractice coverage for independent contractors, if applicable.  Validation of signed and dated confidentiality statements.  Validation of in-service/continuing education participation for all patient care staff.  Validation of exit interview as applicable.  Current CPR for all patient care staff.  Criminal history background checks will be obtained on all contract staff and all individuals seeking employment with the Agency and will be conducted not more than 90 days prior to employment of the individual. o National sex offender registry checks will be obtained on all contract staff and all individuals seeking employment with the agency in a direct patient care position. o The cost of such inquiry shall be paid by either the home care agency or the individual seeking employment. o In order to ensure that the individual does not pose a risk to the health, safety and welfare of the patient, a candidate with a felony conviction on the criminal history record check will not be considered for employment. o In order to ensure that the individual does not pose a risk to the health, safety and welfare of the patient, a candidate with a misdemeanor conviction on the criminal history record check will be interviewed as to the nature of the offense. Additional consideration will be given to the length of time that has passed since the incident. If the length of time and explanation of the incident are satisfactory to the Agency Manager, the candidate may be considered for employment. . Once employed, on-site supervisory home visits will be conducted no less frequently than every 30 days during the first 90 days of employment. - If satisfactory performance during home visits, supervision will continue on-going according to the specific requirements of the job classification.

Professional Pediatric Home Care December 2012 7.9 ACHC Standard HH4-1A.01, HH4-1A.02, HH4-2H.01, HH4-3A.01

- If un-satisfactory performance during home visits, supervision will continue no less frequently than every 30 days until satisfactory performance in maintained for a minimum of 90 days.  Office of Inspector General Exclusion List check will be obtained for all personnel and contract staff providing direct patient care/service or with access to patient records.  Immigration and naturalization statement (I-9) (maintained in separate file).

2. The health record for applicable employees will include:  PPD tests or chest x-ray results. o Chest X-Ray within 6 months of hire. - Repeat Chest X-Ray once every five years thereafter. - Completion of an annual TB risk assessment.  Evidence of HBV: administration or declination.  Any other Agency required health records.

3. Employee health information must be maintained in files separate from personnel files and in a separate location.

4. Personnel records are confidential and will be released only to authorized management for review and to federal, state regulatory and accreditation agencies for inspection.  The Administrator will review all personnel requests to review their personnel record. In the event an employee reviews their record, a manager or supervisor will remain with the employee.  Release of personnel information on current and terminated employees without written authorization from the employee will be limited to verification of date of hire, date of termination and job title.  When unemployment or other type of claim is filed, necessary information will be released as required by law.

5. Personnel records are reviewed on an annual basis.

6. Personnel records will be retained for a period of not less than 7 years.

Professional Pediatric Home Care December 2012 7.9 ACHC Standard HH1-10A, HH4-5A.01

Contractual Staff

______POLICY Contractual staff includes employees of organizations or independent individuals who contract directly with the Agency on an hourly or other basis per visit to provide services to Agency patients according to a written agreement/contract. ______PURPOSE To ensure that the Agency has adequate staff to effectively meet the needs of the home care patient. ______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies ______RELATED DOCUMENTS “Written Agreement/Contract” form ______PROCEDURE 1. All contract personnel shall possess the education and experience to provide services in t he homes of patients in accordance with agency policy, state practice acts and professional st andards of practice as set forth in Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agen cies.

2. All licensed, registered or certified contract personnel providing healthcare services shall, at a minimum, meet the following requirements:  Be qualified as a physician, pharmacist, physician assistant, nurse practitioner, cli nical social worker, social worker, physical therapist, occupational therapist, respiratory t herapist, registered nurse, licensed practical nurse or other provider licensed, registered or certified by the Colorado Department of Regulatory Agencies (DORA).  Meet the requirements for license, certification or registration set forth by DORA.

3. Staff not regulated under DORA shall, at a minimum, meet the following requirements:  A speech-language pathologist shall: o Possess a current certificate of clinical competence in speech pathology or audiology granted by the American Speech-Language-Hearing Association, or o Meet the educational requirements for certification and be in the process of accumulating the supervised experience required for certification.  An occupational therapy assistant shall, at a minimum: o Possess a current certification from the National Board for Certification of Occupational Therapy (NBOT).

Professional Pediatric Home Care December 2012 7.10 ACHC Standard HH1-10A, HH4-5A.01

 A physical therapist assistant shall: o Have completed a physical therapist assistant program accredited by the commission on accreditation in physical therapy or any comparable successor entity; o Be registered, licensed or certified as a physical therapist assistant in another state; or o Be otherwise qualified to take the physical therapy examination.

4. Any personnel under hourly or per visit contracts used by the Agency, there shall be a written employment contract between those personnel and the Agency that specifies the following:  Home care patients are accepted for care only by the primary Agency.  The specific services to be furnished.  The necessity to conform to all applicable agency policies, including personnel qualifications.  The responsibility for participating in developing plans of care or service.  The manner in which services will be controlled, coordinated, and evaluated by the primary Agency  The procedures for submitting service notes, scheduling of visits, periodic patient evaluation.  The procedures for payment for services furnished under the contract.  All services must be: o authorized by the Agency. o furnished in a safe and effective manner by qualified personnel. o delivered in accordance with the patient’s plan of care.

5. A complete statement of Patient Rights, including the right to file a complaint with the Colorado Department of Public Health and Environment, shall be distributed to all contracted personnel upon hire.

6. All contractual staff are duly licensed or certified by their appropriate professional accrediting organization or licensure board prior to providing services to patients, as applicable.

7. Contracted organizations or contractual staff signs a written agreement with the Agency outlining the rules governing services rendered by staff and all associated charges. A copy of the contract will remain in the Agency’s administrative files.

8. Personnel files will be maintained or accessible by the Agency, which includes, at a minimum:  Copy of Written Agreement/Contract.  References or work history.  Licenses/certifications or appropriate documentation per item 3 above.  Current copies of professional liability insurance certificates of coverage for all personnel providing direct service/care and/or organizations providing shared responsibility/care.  Orientation.  Competencies.  Required health tests. Professional Pediatric Home Care December 2012 7.10 ACHC Standard HH1-10A, HH4-5A.01

 Performance appraisals/evaluations.  Any other documentation required by the Agency.  Criminal history record check.  National sex offender registry check.  OIG Exclusions check.  I-9 forms – separate folder.  CPR, if required.  In-service education records.

9. Personnel records will be kept confidential, in accordance with the Agency’s confidentiality policy.

10. Contractual staff or organization will bill the Agency directly for their services rendered to the patients at the negotiated rate. Contractual staff will not bill the patient directly for services rendered on behalf of the Agency under any circumstances.

11. Contractual staff must comply with Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, the Title VI of the Civil Rights Act of 1964, as well as other Agency rules. Contractual staff will be responsible to the Administrator, Director of Nursing and/or Nursing Supervisor.

Professional Pediatric Home Care December 2012 7.10 ACHC Standard HH4-6D.01, HH4-7A.01, HH4-11D, HH4-11E

Supervision of Therapy Assistants

______POLICY Physical, Occupational and Speech Therapy Assistants are supervised by qualified Physical, Occupational and Speech Therapists.

______PURPOSE To ensure the quality of therapy services provided.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______PROCEDURE 1. Services furnished by a Physical Therapy Assistant, Occupational Therapy Assistant or Speech Therapy Assistant will be furnished under the supervision of a qualified Physical, Occupational or Speech Therapist. On-site supervisory visits will occur every 30 to 31 days , as well as review of patient records and case conferences with the assistant to ensure the assistant is practicing appropriately and the patients’ needs are being met. a. Supervision of new employees or employees that are new to the program or service/care being provided will include closer monitoring and more frequent supervision of performance than those with experience. b. Supervision will be provided by the appropriate personnel during regular business hours and by the appropriate nurse or administrator on-call after regular business hours. c. Supervisory visit documentation will be maintained in the patient record.

2. A Physical, Occupational and/or Speech Therapy assistant performs services directed from a written plan of care delegated and supervised by the qualified therapist, assists in preparing clinical notes and progress reports, participates in educating the patient and family and participates in in-service programs.

3. Supervision of new employees or employees that are new to the program or service/care being provided will include closer monitoring and more frequent supervision of performance than those with experience.

4. Supervision will be provided by the appropriate personnel during regular business hours and by the appropriate nurse or administrator on-call after regular business hours.

Professional Pediatric Home Care December 2012 7.11 Administrator Training

______POLICY Administrator will complete initial and annual training or provide documented and confirmed previous job related experience or related education equivalent to successful completion of such program.

______PURPOSE To assure qualifications and appropriate training of the Administrator.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______DEFINITIONS Administrator – is a licensed physician, registered nurse or other licensed healthcare professional, or has experience and education in health service administration; and is qualified by education, knowledge and experience to oversee the services provided; and has at least two years healthcare or health service administration experience with at least one year of supervisory experience in home care or a closely related health program.

First Time Administrator – meets the qualifications of Administrator, but has not been a home health care administrator prior to June 1, 2009.

______PROCEDURE 1. An administrator shall complete 12 clock hours of continuing education within each 12-month period beginning with the date of designation. The education shall include at least two (2) of the following topics and may include other topics related to the duties of the administrator.  Any of the topics listed under the initial training requirements.  Development and implementation of agency policies.  Healthcare management.  Ethics.  Quality improvement.  Risk assessment and management.

Professional Pediatric Home Care December 2012 7.12  Financial management.  Skills for working with patients, families and other professional service providers.  Community resources.  Marketing.

2. For an administrator or alternate administrator who was an administrator prior to June 1, 2009, but had not served as an administrator for 180 days or more immediately preceding the date of designation, at least eight (8) of the 12 clock hours within the first 12 months after designation shall include the topics listed for first time administrators. The remaining four clock hours shall include topics related to the duties of the administrator and include at least two (2) of the topics listed under continuing education. If a previous administrator has not been employed as such for two (2) years or more, the requirements for a first time administrator apply.

3. A first-time administrator or alternate administrator shall complete a total of 24 hours of training in the administration of an agency before the end of the first 12 months after designation to the position.

4. A first-time administrator or alternate administrator shall complete eight (8) clock hours of educational training in the administration of an agency within the first month of employment. The eight (8) clock hours shall include, at a minimum, the following topics:  Home care overview,  Information on the licensing standards for the agency; and  Information on state and local laws applicable to the agency.

5. A first-time administrator or alternate administrator shall complete an additional 16 clock hours of educational training before the end of the first 12 months after designation to the position. Any of the 16 hours may be completed prior to designation if completed during the 12 months immediately preceding the date of designation to the position. The additional 16 clock hours shall include the following subjects and may include other topics related to the duties of an administrator:  Patient rights, governing body and administrator responsibilities, professional advisory committee, quality management plans, occurrence reporting, and complaint investigation and resolution process.  Personnel qualifications, experience, competency and evaluations.  Financial management.  Ethics in healthcare.  Needs of the fragile, ill and physically and cognitively disabled in the community setting with special training and staffing considerations.  Behavior management techniques.  Staffing methodologies and oversight of scheduling.  Staff training and supervision.  Limitations of personal care versus health care services.

Professional Pediatric Home Care December 2012 7.12 6. The 24-hour education requirement shall be met through structured, formalized classes, correspondence courses, competency-based computer courses, training videos, distance learning programs, or other training courses. Subject matter that deals with the internal affairs of an organization does not qualify for credit. The training shall be provided or produced by an academic institution, a recognized state or national organization or association, an independent contractor, or an agency.  If an agency or independent contractor provides or produces training, the training shall first be approved by the department or recognized by a national organization or association. The agency shall maintain documentation of this approval for review by inspectors.

7. Documentation of administrator or alternate administrator training must be on file at the agency and contain the name of the class or workshop, the course content or curriculum, the hours and dates of the training, and the name and contact information of the entity and trainer who provided the training.

8. After completion of the 24 hours of educational training within the first 12 months after designation as a first-time administrator or alternate administrator, each must then complete the continuing education requirements in each subsequent 12-month period after designation.

Professional Pediatric Home Care December 2012 7.12 ACHC Standard HH2-7B.01, HH2-8B.01, HH4-5A.01, HH4-5B.01, HH7-1B.01, HH7-2A.01, HH7-2B.01, HH 7-3B.01 Employee Orientation

______POLICY Each employee of the Agency will complete an orientation period. ______PURPOSE To provide a mechanism whereby all employees are oriented to and become acquainted with the Agency policies and procedures. ______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies ______RELATED DOCUMENTS “Orientation Checklist” form ______PROCEDURE 1. Orientation is conducted with all staff prior to their assuming patient care responsibilities.

2. Orientation will be conducted by the agency Administrator/Director of Nursing or a qualified designee.

3. Orientation for all employees will be performed and documented at the time of hire and will include:  Employee duties and responsibilities.  Salary scales/ranges for the position that the employee will occupy, overtime and holiday pay.  Benefits (communicate which benefits are provided and in writing if no benefits are provided).  A description of the services provided by the agency.  The differences in personal care, nurse aide care and skilled health care in the home including limiting factors for the provision of personal care.  Patient rights including freedom from abuse or neglect, and confidentiality of patient records, personal, financial and health information; o A complete statement of Patient Rights, including the right to file a complaint with the Colorado Department of Public Health and Environment, shall be distributed to all employees and contracted personnel upon hire.  Hand washing and infection control.  Assignment and supervision of services.  Observation, reporting and documentation of patient status and services furnished.

Professional Pediatric Home Care December 2012 7.17 ACHC Standard HH2-7B.01, HH2-8B.01, HH4-5A.01, HH4-5B.01, HH7-1B.01, HH7-2A.01, HH7-2B.01, HH 7-3B.01

 Emergency response policies and emergency contact numbers for the agency and for the individual patient assigned.  Training and competency evaluation of appropriate and safe techniques in all tasks specific to job requirements.  Training and evaluation of OASIS competency for all disciplines involved in the completion and review of OASIS paperwork.

4. The Orientation Checklist identifies the orientation requirements and will be used to document orientation for all staff, including contract staff.

Professional Pediatric Home Care December 2012 7.17 ACHC Standard HH2-3A.01, HH2-5A, HH2-7B.01, HH2-8A.01, HH2-8B.01, HH3-4B.01, HH4-5A.01, HH7-1B.01, HH7-2A.01, HH7-2B.01, HH7-2C.01, HH7-3B.01

ORIENTATION CHECKLIST

EMPLOYEE: ______POSITION: ______

ORIENTATION TO YES N/A INTIALS/DATE Job description, training specific to job requirements Services provided by the agency, charges and conveying of charges The differences in personal care, nurse aide care and skilled health care in the home including limiting factors for the provision of personal care Complete statement of Patient Rights, including the right to file a complaint Infection Control a. Personal hygiene (e.g., PPE & handwashing) b. Communicable infections (TB, AIDS, etc.) patient, employee c. Cleaning/disinfecting reusable equipment d. Precautions to be taken (Standard Precautions, airborne transmission, direct/indirect contact, compromised immunity) e. Handling/disposal of infectious wastes f. Tuberculosis Program/Plan (OSHA) g. Bloodborne Pathogen Program (OSHA) Conflict of Interest policy Observation, reporting and documentation of patient status and the service furnished, assignment and supervision of services Emergency response policies and emergency contact numbers for the agency and for the individual patient assigned Occurrence reporting and procedures to follow Privacy and confidentiality of patient information/HIPPA policies and procedures Community resources Agency Policies and Procedures Advance Directives Policies and Procedures Screening for alleged or suspected victims of abuse/neglect reporting; protective services for at risk adults / children, as applicable; professional boundaries. Emergency preparedness plan & role Equipment use/management relevant to job description Managing the environment of care: OSHA a. Safety – ensure safety and security of patient b. Basic first aid c. Fire safety – fire escape, fire alarm system, fire extinguishers – and prevention d. Security – Personal safety during home visits e. Utilities – bathroom, kitchen, electrical

Professional Pediatric Home Care December 2012 7.17A ACHC Standard HH2-3A.01, HH2-5A, HH2-7B.01, HH2-8A.01, HH2-8B.01, HH3-4B.01, HH4-5A.01, HH7-1B.01, HH7-2A.01, HH7-2B.01, HH7-2C.01, HH7-3B.01

ORIENTATION TO YES N/A INTIALS/DATE f. Responding to emergencies OSHA (Right to Know laws) Agency complaint mechanism/ state hotline # and purpose Quality management program & role Agency hours of operation, on-call and answering service Ethical aspects of care, treatment and services and process to address ethical issues Philosophy/mission//vision/goals/services provided Provision of care/service to patients and families with communication barriers: interpreters/communicating with hearing/speech/visually impaired/ special circumstances Personnel physical safety (e.g., body mechanics and safe lifting) Cultural diversity and sensitivity Coordination with external home care agencies Family/State Medical Leave Act Organizational chart, lines of authority & responsibility Role of Governing Body Employee handbook/policies and procedures Missed visit policy and procedure Equal Employment Opportunity &Sexual Harassment Act Professional Boundaries Salary/hourly wage reimbursement Unemployment and Workers’ Compensation Patient/Caregiver education OASIS documentation Compliance program, fraud and abuse laws

Other

(Note: See Job-specific Competency Checklist for Skills)

Employee Signature Date

Supervisor Signature/Initials Date

Professional Pediatric Home Care December 2012 7.17A ACHC Standard HH2-8B.01, HH4-6A.01, HH4-8A, HH4-8A.01, HH4-12A, HH7-2A.01, HH7-2B.01 In-service Education/On-going Training

______POLICY Regularly scheduled and appropriate in-service programs will be made available for all employees.

______PURPOSE To ensure the continuing education of all Agency personnel.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______PROCEDURE 1. On-going training will be provided to all direct care staff, consistent with the program, services and equipment the agency provides and appropriate to the needs of the populations served and the discipline of the employee.  Direct care staff must have a minimum of 12 hours of in- service/continuing education per year.  Non direct care staff must have a minimum of 8 hours of in-service/continuing education per year.

2. The employee will be responsible for attending in-service and training programs and maintaining compliance with the in-service and training requirements for his/her position.

3. The Agency may allow employees to attend in-service and training programs during the course of their work day and may give time off with pay.

4. In-service and training programs not sponsored or authorized by the Agency may be attended during the work day with express approval of the Agency.

5. Payment of registration fees and related expenses will be at the discretion of the Agency with prior approval from the appropriate supervisor(s).

6. An absence will not be counted against an employee when he/she is authorized or assigned to attend a conference, convention or training program directly related to his/her working position. The employee will be considered as working.

7. Training shall consist of at least 12 topics applicable to the agency’s care and services every 12 months after starting date of employment or calendar year as designated by agency policy. The training requirement shall be prorated in

Professional Pediatric Home Care December 2012 7.18 ACHC Standard HH2-8B.01, HH4-6A.01, HH4-8A, HH4-8A.01, HH4-12A, HH7-2A.01, HH7-2B.01

accordance with the number of months the employee was actively working for the agency. Training shall include, but is not limited to, the following items:  Promoting patient dignity, independence, self-determination, privacy, choice and rights; including abuse and neglect prevention and reporting requirements.  Behavior management techniques.  Disaster and emergency procedures.  How to handle complaints/grievances.  Infection control including universal precautions.  OSHA (Right to Know laws)  Ethical issues.  Varying cultural backgrounds, beliefs and languages.  Communication barriers.  Safety training for staff in regards to workplace, patient and personal safety.

8. Employee feedback will be obtained through random surveys regarding educational needs and areas of knowledge deficit when planning in-service education.

9. Ongoing education, including in-services are provided:  To increase staff knowledge of work-related issues.  To meet the needs of the patients served.  When job duties for an employee change.  To comply with applicable law and regulation (e.g., OSHA).  To emphasize safety and infection prevention and control as applicable to each employee’s job responsibilities.  To continually reinforce the need and ways to report unanticipated adverse events.

10. Education programs will incorporate team training methods, as appropriate.

11. All in-service and training programs will be documented.  Classroom and laboratory type training shall be documented with the date of the training; starting and ending times; instructors and their qualifications; short description of content; and staff member’s signature. Documentation will be kept in a binder for ongoing education and an individual listing of ongoing education will be kept in the employee’s file  On-line or self-study training shall be documented with information as to the content of the training and the entity that offered or produced the training  Methods of providing education may include journals, reference materials, books, internet learning, in house lectures and demonstrations and access to external learning opportunities.

Professional Pediatric Home Care December 2012 7.18 ACHC Standard HH4-6A.01, HH4-6B.01, HH4-12A Staff Competency Program

______POLICY The Agency will provide for initial and ongoing competency assessments for all patient care staff by qualified individuals.

______PURPOSE To define the staff competency program.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______RELATED DOCUMENTS “Initial Competency Checklist” and “Annual Competency Checklist” discipline-specific checklists

______PROCEDURE 1. Patient care staff will be competency assessed at defined intervals:  For each new employee (including contract employees) during orientation.  Annually for all patient care staff.  Competency assessment will include on-site joint home visit.  When introducing new procedures/techniques/equipment.

2. Patient care staff’s competencies are maintained and improved through:  In-service and/or continuing education.  Trends in infection control, incident reporting and performance improvement activities.  Specialty certification.

3. The Agency has established competency criteria for each job category. Qualified individuals will observe the employee during competency evaluation. The competency evaluation checklist will be completed and retained in the employee’s record.

4. Examples of qualified individuals to perform competency assessments may include:  Licensed Practical Nurse: competency assessed by RN.  Registered Nurse: competency assessed by a peer RN.

Professional Pediatric Home Care December 2012 7.19 ACHC Standard HH4-6A.01, HH4-6B.01, HH4-12A  Physical Therapist: competency assessed by a peer PT or Rehab Supervisor.  Occupational Therapist: competency assessed by a peer OT or Rehab Supervisor.  Speech Language Pathologist: competency assessed by a peer SLP.  Medical Social Worker: competency assessed by a peer MSW or RN.  Medical Social Worker Assistant: competency assessed by an MSW.  Physical Therapy Assistant: competency assessed by PT.  Certified Occupational Therapy Assistant: competency assessed by OT.

5. In the event that the staff does not perform satisfactorily on a task, the staff will be re-trained and be required to demonstrate the task in a satisfactory manner. This will be documented on the competency evaluation.

6. No staff member will perform a task independently prior to successful competency verification.

7. All competency assessments will be documented and retained in employee files.

Professional Pediatric Home Care December 2012 7.19 ACHC Standard HH4-6A.01, HH4-12A

INITIAL COMPETENCY CHECKLIST RN/LPN/LVN

NAME ______RN ______LPN/LVN _____

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO 1. Urinary catheters: a. Foley insertion–male/female b. Suprapubic insertion/removal 2. Central Catheter Lines 3. Enteral Feedings: a. Bolus b. Continuous c. Removal/insertion PEG tubes 4. Equipment: a. IV pumps b. Enteral pumps c. Oxygen concentrator d. Oxygen tank e. Nebulizer 5. IV therapy: a. Peripheral/INT b. Admin fluids/meds c. Dressing change 6. Irrigations: a. Bladder b. Colostomy 7. Suctioning: a. Nasal b. Oral . c. Tracheal

Professional Pediatric Home Care December 2012 7.19A ACHC Standard HH4-6A.01, HH4-12A

Initial Competency Checklist RN/LPN/LVN…continued

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & INITIAL INITIAL YES NO YES NO 8. Tracheostomy Care 9. TPN: a. Administration b. Labs c. Starting/stopping d. Additives 10. Venipuncture 11. Transporting lab specimens 12. FSBG/Glucometer 13. PT/INR 14. Wound care: a. Aseptic technique b. Sterile technique 15. Standard Precautions: a. Gloves b. Gowns c. Masks/goggles d. Shoe covers e. CPR resusci-masks OASIS Documentation

DATE OF INITIAL COMPLETION: ______

Professional Pediatric Home Care December 2012 7.19A ACHC Standard HH4-6A.01, HH4-12A

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19A ACHC Standard HH4-6A.01, HH4-12A INITIAL COMPETENCY CHECKLIST Physical Therapist

NAME: ______TITLE: ______

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO I. Evaluation & Treatment 1. ROM/Goniometry 2. Strength 3. Balance 4. Coordination 5. Functional mobility: a. Bed mobility b. Transfers c. W/C mobility d. Gait 6. Sensation 7. Muscle tone 8. Endurance 9. Positioning 10. Patient teaching 11. Body mechanics II. Equipment: 1. Gait devices: a. Walker b. Crutches c. Hemiwalker d. Quad cane e. Straight cane f. Platforms for walker/crutches . 2. Other: a. Wheelchair b. Sliding board

Professional Pediatric Home Care December 2012 7.19B ACHC Standard HH4-6A.01, HH4-12A

Initial Competency Checklist PT…continued

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & INITIAL INITIAL 3. Exercise aids: YES NO YES NO a. Overhead pulley b. Free weights c. CPM 4. Modalities: a. Ultrasound b. TENS c. Hot pack d. Cold pack e. Splints f. AFO g. Back brace: h. Cervical collar i. Knee immobilizer OASIS Documentation

DATE OF INITIAL COMPLETION: ______

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19B ACHC Standard HH4-6A.01, HH4-12A INITIAL COMPETENCY CHECKLIST Physical Therapy Assistant

NAME: ______TITLE: ______

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO I. Re-evaluation & Treatment 1. ROM/Goniometry 2. Strength 3. Balance 4. Coordination 5. Functional mobility: a. Bed mobility b. Transfers c. W/C mobility d. Gait 6. Sensation 7. Muscle tone 8. Endurance 9. Positioning 10. Patient teaching 11. Body mechanics II. Equipment: 1. Gait devices: a. Walker b. Crutches c. Hemiwalker d. Quad cane e. Straight cane f. Platforms for walker/crutches . 2. Other: a. Wheelchair b. Sliding board

Professional Pediatric Home Care December 2012 7.19C ACHC Standard HH4-6A.01, HH4-12A

Initial Competency Checklist PTA…continued

DATE OF INITIAL COMPLETION: ______

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19C ACHC Standard HH4-6A.01, HH4-12A INITIAL COMPETENCY CHECKLIST Speech Language Pathologist

NAME: ______TITLE:

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO Able to evaluate, recommend restorative potential and provide a therapeutic plan for: 1. Voice disorders: a. Electrolarynx b. Esophageal speech 2. Dysphasia 3. Language disorders 4. Non-oral communication 5. Articulation disorders OASIS Documentation

DATE OF INITIAL COMPLETION: ______

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19D ACHC Standard HH4-6A.01, HH4-12A INITIAL COMPETENCY CHECKLIST Medical Social Worker

NAME: ______TITLE:

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO Provide skilled assess of social & emotional factors Provide assess of pt’s need for long- term care Evaluate home/family situation Counsel and assist with out-of-home placement Promote community services and provide education Provide advocacy, referral and linkage with community services Counsel and assist with financial problems and entitlements Provide goal-oriented intervention directed toward management of a terminal illness Assist with strengthening the family support system Assist with resolution of conflict related to illness Identify and advocate for patients at risk for physical or mental abuse and/or neglect Identify and evaluate patients at high risk for suicide Identify and evaluate patients with inadequate food, medications and/or medical supplies Develop care plan according to patient needs & physician orders

DATE OF INITIAL COMPLETION: ______

Professional Pediatric Home Care December 2012 7.19E ACHC Standard HH4-6A.01, HH4-12A

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19E ACHC Standard HH4-6A.01, HH4-12A INITIAL COMPETENCY CHECKLIST Occupational Therapist

NAME: ______TITLE: ______

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO Evaluate and perform active and passive ROM Evaluate and perform muscle strengthening activities Evaluate and train ADLs/IADLs Evaluate and train self care Evaluate and train home management tasks Evaluate and train leisure activities Evaluate and recommend home modifications Evaluate, recommend and/or fabricate UE orthotic’s/splints Evaluate and train functional mobility Evaluate and train cognitive skill related to ADLs/IADLs Evaluate, train and/or fabricate adaptive equipment Demonstrates ability to perform standard evaluation (e.g., dynamometer, pinch gauge, goniometer) OASIS Documentation

DATE OF INITIAL COMPLETION: ______

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19F ACHC Standard HH4-6A.01, HH4-12A INITIAL COMPETENCY CHECKLIST Occupational Therapy Assistant

NAME: ______TITLE: ______

Self Training Observer Assessm Co Assessm ent mp ent lete d COMPETENT DATE & COMPETENT DATE & SKILLS INITIAL INITIAL YES NO YES NO Re-evaluate and perform active and passive ROM Re-evaluate and perform muscle strengthening activities Re-evaluate and train ADLs/IADLs Re-evaluate and train self care Re-evaluate and train home management tasks Re-evaluate and train leisure activities Re-evaluate and recommend home modifications Re-evaluate, recommend and/or fabricate UE orthotic’s/splints Re-evaluate and train functional mobility Re-evaluate and train cognitive skill related to ADLs/IADLs Re-evaluate, train and/or fabricate adaptive equipment

DATE OF INITIAL COMPLETION: ______

Employee Signature/Title Observer Signature/Title

Professional Pediatric Home Care December 2012 7.19G ACHC Standard HH4-6A.01, HH4-12A ANNUAL COMPETENCY ASSESSMENT

Skilled Nurse

NAME: ______TITLE: ______

Competency assessed on-site: in patient home ____

NEEDS DEMONSTRATED COMPETENCY IN: COMPETENCY IMPROVEMENT Patient rights/responsibilities Agency complaint mechanism Respect of patient property Basic home safety Infection control/standard precautions Communicating with patient Patient assessment/reassessment Patient education Emergency management plan Home care record documentation/OASIS Care Observed: Venipuncture: Competent YES_____ NO_____ Wound Care: Competent YES_____ NO_____ Foley Insertion: Competent YES_____ NO_____ IV Start: Competent YES_____ NO_____ Employee competent to provide care? YES_____ NO_____ Needs improvement? YES_____ NO_____ If needs improvement, explain:

______Qualified Observer Signature/Title Date

______Employee Signature Date

Professional Pediatric Home Care December 2012 7.19J ACHC Standard HH4-6A.01, HH4-12A ANNUAL COMPETENCY ASSESSMENT

Physical Therapist/Physical Therapy Assistant

NAME: ______TITLE: ______

Competency assessed on-site: in patient home ____

Active/Passive ROM Exercises: Competent YES____ NO____ Gait Training: Competent YES____ NO____ Employee competent to provide care? YES_____ NO_____ Needs improvement? YES_____ NO_____ If needs improvement, explain:

______Qualified Observer Signature/Title Date

______Employee Signature Date

Professional Pediatric Home Care December 2012 December 2012 7.19K ACHC Standard HH4-6A.01, HH4-12A ANNUAL COMPETENCY ASSESSMENT

Speech Language Pathologist

NAME: ______TITLE: ______

Competency assessed on-site: in patient home ____

NEEDS DEMONSTRATED COMPETENCY IN: COMPETENCY IMPROVEMENT Patient rights/responsibilities Agency complaint mechanism Respect of patient property Basic home safety Infection control/standard precautions Communicating with patient Patient assessment/reassessment Patient education Emergency management plan Home care record documentation/OASIS Care Observed: Swallowing Disorders: Competent YES_____ NO_____ Communication Disorders: Competent YES_____ NO_____ Employee competent to provide care? YES_____ NO_____ Needs improvement? YES_____ NO_____ If needs improvement, explain:

______Qualified Observer Signature/Title Date

______Employee Signature Date

Professional Pediatric Home Care December 2012 7.19L ACHC Standard HH4-6A.01, HH4-12A ANNUAL COMPETENCY ASSESSMENT

Medical Social Worker/Medical Social Work Assistant

NAME: ______TITLE: ______

Competency assessed on-site: in patient home ____

NEEDS DEMONSTRATED COMPETENCY IN: COMPETENCY IMPROVEMENT Patient rights/responsibilities Agency complaint mechanism Respect of patient property Basic home safety Infection control/standard precautions Communicating with patient Patient assessment/reassessment Patient education Emergency management plan Home care record documentation Care Observed: Financial Planning: Competent YES____ NO____ Accessing Community Resources: Competent YES____ NO____ Employee competent to provide care? YES_____ NO_____ Needs improvement? YES_____ NO_____ If needs improvement, explain:

______Qualified Observer Signature/Title Date

______Employee Signature Date

Professional Pediatric Home Care December 2012 7.19M ACHC Standard HH4-6A.01, HH4-12A ANNUAL COMPETENCY ASSESSMENT

Occupational Therapist/Occupational Therapy Assistant

NAME: ______TITLE: ______

Competency assessed on-site: in patient home ____

Adaptive Equipment: Competent YES_____ NO_____ ADL's: Competent YES_____ NO_____ Employee competent to provide care? YES_____ NO_____ Needs improvement? YES_____ NO_____ If needs improvement, explain:

______Qualified Observer Signature/Title Date

______Employee Signature Date

Professional Pediatric Home Care December 2012 7.19N ACHC Standard HH4-2I Job Description

______POLICY There is a written job description for each position within the Agency and each employee will be furnished with a job description upon employment.

______PURPOSE To outline the responsibilities, requirements and scope of each position.

______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

______RELATED DOCUMENTS “Job Description” forms

______PROCEDURE 1. Each job description will clearly define the role, responsibilities and requirements for each position.

2. The job description will include, at a minimum:  Job duties.  Reporting responsibilities.  Minimum job qualifications, experience requirements, education and training.  Requirements for the job.  Physical and environmental requirements with or without reasonable accommodation.

3. Each employee will be given a current job description to review and sign upon hire, during the annual performance evaluation and whenever the job description changes.

4. When a supervisor does not have appropriate clinical training and experience for a clinical specialty area, the agency provides access to qualified consultation.

Professional Pediatric Home Care December 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Administrator JOB SUMMARY:

The Administrator plans, develops and directs the programs, services, activities and employees of the Agency.

QUALIFICATIONS:

1. Is a licensed physician, registered nurse or other licensed healthcare professional, or has experience and education in health service administration. 2. Is qualified by education, knowledge and experience to oversee the services provided. 3. Has at least two years healthcare or health service administration experience with at least one year of supervisory experience in home care or a closely related health program. 4. Has the appropriate education and experience as defined by the governing board/owner and any applicable state and federal laws and regulations. 5. Successful completion of or ability to successfully complete, initial and annual administrator training per the requirements of 6 CCR 1011-1 Chapter 26 section 7.6.  Exceptions to the training requirements will be made only when the Administrator meets the requirements of 6 CCR 1011-1 Chapter 26 section 7.6(H). 6. Excellent verbal and written communication skills and strong interpersonal skills. 7. Knowledge of regulatory requirements at the federal, state and local levels, as well as knowledge of Agency policies and procedures. 8. At least 21 years of age.

LINE OF AUTHORITY: Reports to the Governing Body/Agency Ownership

RESPONSIBILITIES:

1. Ensure the Agency’s skilled health services are in compliance with all applicable regulations, Accrediting Organization standards (if applicable), and federal, state, and local laws. 2. Ensures the completion, maintenance and submission of such reports and records as required by the Colorado Department of Public Health and Environment. 3. Ensures the Agency’s ongoing liaison with the Governing Body, Professional Advisory Committee, staff members and the community. 4. Maintains a current organizational chart to show lines of authority down to the patient level. 5. Develops and implements objectives, manages all business affairs and the overall operation of the Agency. 6. Ensures the maintenance of appropriate personnel, financial and administrative records and all policies and procedures of the agency. 7. Employs qualified personnel in accordance with written job descriptions and ensures adequate staff education, supervision and evaluations. 8. Ensures orientation of new staff, regularly scheduled in-service education programs and opportunities for continuing education for the staff. 9. Designation, in writing, of a qualified staff member to act in the absence of the administrator. 10. Ensures availability of the administrator or designee for all hours that employees are providing services, at minimum, any eight (8) hour period between 7 a.m. and 7 p.m. Monday through Friday. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

11. Job Description – Administrator…continued

12. Ensures all marketing, advertising and promotional information and activities accurately represents the Agency and addresses the care, treatment and services that the Agency can provide directly or through contractual arrangement. 13. Plans, organizes and directs the Agency’s ongoing functions by delegating duties and establishing a formal means of staff accountability. 14. Implements Agency policies and procedures. 15. Directs and coordinates the overall development and administration of the Agency consistent with the Agency mission and available resources, and with the involvement of the Agency staff and participation of the Professional Advisory Committee. 16. Provides leadership in the development of strategic long-term plans. 17. Appoints person responsible for the implementation of the infection control program 18. Evaluates effectiveness and efficiency of the Agency services and programs. 19. Directs daily business activities of the Agency and assures development of systems that support recruitment, hiring and the ongoing professional development of Agency staff. 20. Participates in the hiring and orientation of staff, and development of continuing education (staff development) in applicable policies, rules, regulations and resource materials. 21. Establishes criteria and procedures for selection, promotion, discipline and termination of employment of personnel. 22. Develops and implements employee compensation program. 23. Ensures that confidentiality and privacy procedures are adopted and followed. 24. Serves as a resource person to employees. 25. Develops implements and evaluates budget plan and cost control methods. 26. Establishes and maintains effective means of communication. 27. Serves on the Professional Advisory Committee and Quality Management Committee. 28. Appoints members and their terms of membership to the Quality Management Committee. 29. Ensures 24 hour/day, seven (7) days/week on-call coverage. 30. Implements an effective budgeting and accounting system; assures accuracy for billing procedures. 31. Monitors equipment use and takes steps to keep abuse to a minimum. 32. Uses statistical data to determine quality and quantity of services. 33. Participates in personal professional growth and development. 34. Ensure Agency personnel have current clinical information and current practices. 35. Maintains current knowledge of local trends and issue. 36. Completes initial and annual administrator training, as applicable, per the requirements of 6 CCR 1011-1 Chapter 26 section 7.6.

WORKING ENVIRONMENT:

Works indoors in the home health office, travels to referral sources and possibly to patients’ homes.

JOB RELATIONSHIPS:

1. Supervised by: Governing Body / Agency Ownership 2. Workers Supervised: Entire home health care staff

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Administrator…continued RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Administrator…continued

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

PHYSICAL DEMANDS WORK ENVIRONMENT On-the-job time is spent in the following physical activities. Show This job requires exposure to the following environmental conditions. Show the amount of time by checking the appropriate boxes below. Show the amount of time by checking the appropriate boxes below.

None Up to 1/3 1/3 None Up 1/3 2/3 1/3 to ½ and to to and more 1/3 1/2 more Stand √ Wet, humid conditions (non-weather) √ Walk √ Work near moving mechanical parts √ Sit √ Fumes or airborne particles √ Talk or hear √ Toxic or caustic chemicals √ Use hands to finger, handle or feel √ Outdoor weather conditions √ Push/pull √ Extreme cold (non-weather) √ Stoop, kneel, crouch or crawl √ Extreme heat (non-weather) √ Reach with hands and arms √ Risk of electrical shock √ Taste or smell √ Work with explosives √ Risk of radiation √ Vibration √ This job requires that weight be lifted or force be exerted. Show how much & how often by checking the appropriate boxes below REPETITIVE MOTION ACTIONS None Up to 1/3 2/3 The typical noise level for the environment for the work- Numberenvironment of Hours is: (Check - This job has special vision requirements; check1/3 all thatto apply ½ and Repetitiveall that apply use) of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) more Right only √ Up Distance to 10 pounds Vision (clear vision at 20 feet or more) √ Left Very only Quiet  Loud Noise√  Quiet Up Color to 25 Visionpounds (ability to identify and distinguish colors)√ Both Moderate Noise  Very Loud√ Noise Up Peripheral to 50 pounds Vision √ Repetitive use of Hands Hearing: Up Depth to 100 Perception pounds √ Right only  Ability to hear alarms on equipment More Ability than to100 Adjust pounds Focus √ Left only  Ability to hear patient call  No Special Vision Requirements Both Ability to hear instructions from staff √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Administrator…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as Administrator, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Director of Clinical Services

JOB SUMMARY:

The Director of Clinical Services provides supervision of home care services to patients in their place of residence and strives to provide the highest quality of care. The DCS (or qualified alternate) is available at all times during operating hours and participates in all activities relevant to the professional services furnished, including the development of qualifications and the assignment of personnel.

QUALIFICATIONS: 1. The skilled nursing and other therapeutic services furnished are under the supervision and direction of a physician or a registered nurse. 2. Two (2) years home health nursing experience, minimum. 3. At least two (2) years healthcare experience in the field of supervision including one year supervisory experience in home care or a closely related service. 4. Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing. 5. Acceptance of philosophy and goals of Agency. 6. Ability to exercise initiative and independent judgment. 7. Ability to work with individuals to enlist cooperation of many people to perform/achieve a common goal.

LINE OF AUTHORITY: Reports to the Governing Board

RESPONSIBILITIES: 1. Understands and adheres to all applicable regulations, standards, and federal, state, and local laws and established Agency policies and procedures. 2. Supervises the development of standards which ensure safe and therapeutically effective service to patient/family. 3. Ability to supervise, guide and develop patient care, personnel skills and performances. 4. Consults with the Nursing Supervisors in determining a staffing pattern which will accomplish stated objectives and promote a maximum level of utilization of patient care personnel. 5. Responsible for recruiting, hiring, evaluating and terminating personnel. Assists in instituting, interpreting and documenting disciplinary action. 6. Oversees the orientation of new patient care personnel. 7. Assists in the planning and consultative needs of staff. 8. Responsible for the preparation and implementation of policies and procedures which meet Medicare, Medicaid, Accrediting Organization (if applicable), and federal, state and local laws. 9. Supports policies and procedures and uses appropriate channels for changes of such policies. 10. Responsible for the coordination of interdisciplinary team services. 11. Ensures availability of Nursing Supervisors for all hours that employees are providing services, at minimum, any eight (8) hour period between 7 a.m. and 7 p.m. Monday through Friday.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description - Director of Nursing…continued

12. Responsible for the organization of patient care services to delineate and delegate functional responsibility, lines of relationship and communication to provide safe and therapeutically effective service. 13. Responsible for the coordination of Agency’s services with the services of other community agencies. 14. Participates in studies and research and other administrative functions as assigned. 15. Observes confidentiality and safeguards all patient related information. 16. Accepts responsibility for regular attendance and punctuality; fulfills job related requirements without regard to time involved. 17. Serves as a resource person to employees. 18. Develops a cooperative relationship and communicates effectively and professionally with physicians and referral sources. 19. Investigates, resolves and reports any problem relating to patient care and/or employee well- being. 20. Immediately investigates and resolves any accident, incident, lost articles or unusual occurrence and reports to the Governing Board as necessary. 21. Attends pertinent continuing education programs other than routine in-services and shares information with staff. 22. Monitors equipment for appropriate use and takes steps to keep misuse to a minimum. 23. Responsible for the Agency’s ongoing Quality Management (QM) program as the QI Coordinator. Assists with the overall development and implementation of the QM plan, the identification of goals related to patient outcomes and coordinating, participating, and reporting of activities and outcomes results. 24. Functions as Agency infection control manager. 25. Provides supervision for Nursing Supervisors as they develop, implement and evaluate patient plans of care. 26. Responsible for the review of patient medical records for compliance with federal, state and local laws, Accrediting Organization standards (if applicable), and Agency policies and guidelines. 27. Assists Nursing Supervisor in conducting patient care conferences, staff meetings and maintains documentation. Participates in community education projects. 28. Ensures that all necessary supplies and equipment are available. 29. Uses statistical data to determine quality and quantity of services. 30. Participates in personal professional growth and development. 31. Ensures Agency personnel have current clinical information and current practices. 32. Maintains current knowledge of local trends and issue. 33. Completes initial and annual administrator training, as applicable, per the requirements of 6 CCR 1011-1 Chapter 26 section 7.6. 34. Must be able to perform nursing functions in times of staff shortage. 35. Available to share on-call with nursing personnel as needed. 36. Ensures that documentation is completed in accordance with Agency policy. 37. Assists with staffing visit assignments at Nursing Supervisors request. 38. Other duties as assigned by the Governing Board.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description - Director of Nursing…continued

WORKING ENVIRONMENT: Works indoors in Agency office and travels to/from patient homes.

JOB RELATIONSHIPS: 1. Supervised by: Governing Board 2. Workers Supervised: Entire home health patient care staff

RISK EXPOSURE: High risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description - Director of Nursing…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only √  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein and I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Controller

JOB SUMMARY:

The Controller will manage and direct the organization’s finance, accounting, billing, collections, budgets, insurance, and internal controls. The position will maintain the financial records in adherence with GAAP accrual accounting requirements. This position will strive to help the Company grow will take on a significant responsibility in the organization and develop and maintain a first class accounting and finance department.

QUALIFICATIONS:  Bachelor’s Degree in Accounting required. An advanced degree in business a plus.  Minimum 3-5 years’ experience as a controller in healthcare organization.  Recent experience with Medicare/Medicaid billing  Advanced knowledge of healthcare accounting  Experienced user of QuickBooks

LINE OF AUTHORITY: Reports to the President

RESPONSIBILITIES:  Convert the companies cash basis books to accrual basis (initially)  Develop and maintain all appropriate internal controls in conjunction with the President.  Manage accounting and payroll activities as well as accounting functional areas (invoice processing, billing, cash receipts, receivable collections, month-end close, journal entries, statistical data, and payroll).  Ensure that all internal and external reporting deadlines are met.  Manage workflow, timeliness and analytical review of all budget and forecast data.  Manage and provide necessary support to financial audits including internal audits, external audits and peer reviews.  Perform other job-related duties as assigned or apparent.

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

1. Supervised by: President

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Controller…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Job Description – Controller…continued Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Controller, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Business Development Manager

JOB SUMMARY: The primary responsibilities of a Business Development Manager are to build relationships with referral sources, and community organizations and to recognize and develop areas of growth that will result in revenue generation. A Business Development Manager plays a major role in ensuring quality service delivery and performs tasks that help the organization deliver our services effectively. QUALIFICATIONS: 1. Education: College degree required; advanced degree preferred. 2. Experience: Minimum of 5 years healthcare or health service administration experience with at least 3 years of supervisory experience in home care or related health field. Previous experience with company expansion preferred. 3. Personality: Strong leadership and consensus building skills; marketing management and strategic planning experience. Ability to lead cross-functional teams, drive change, and develop relationships at all levels. 4. Required Skills: Must be a self-starter, highly organized, and able to work well with individuals at all levels in the organization. Polished presentation and interpersonal skills. 5. Must have strong project management skills, strategic and analytical skills, and planning and problem- solving skills. 6. Exceptional customer focus skills; able to see the impact of decisions and actions on company, healthcare providers, and family, and shape direction accordingly.

LINE OF AUTHORITY: Reports to the President. RESPONSIBILITIES/ESSENTIAL FUNCTIONS: Responsibilities: 1. Research, develop and implement a Brand and Communication strategy, standards and practices company-wide that elicit the behavior, emotion and recognition objectives of the company. 2. Development of key messages for all audiences to communicate our core brand identity. 3. Lead agencies and internal team members where appropriate to execute all communication activities and public relations (marketing materials, advertising, client communications, direct mail, marketing campaigns, press releases, content for trade publications, etc.). 4. Oversee the writing of press releases, copy for marketing materials, annual reports, advertisements, and other related material. 5. Manage media relations, research marketing opportunities and build relationships with key industries. 6. Work closely with the Web Manager to ensure messaging is consistent with overall marketing and communication objectives. 7. Build and maintain strong relationships with internal and external key stakeholders to ensure proper messaging of company beliefs and service offerings. 8. Provide reporting to the President as well as at Board of Director meetings. Will include but not be limited to reporting on the status of prioritized marketing and communication activities. Reporting will be both historical and forward looking. 9. Develop and manage the communications budget. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Business Development Manager…continued

10. Contributes to the total effectiveness of the department, communicating openly, solving problems proactively, offering creative ideas and working as a positive, engaged team member. 11. Budget management. To deliver all marketing activity within the agreed budget. 12. To manage all aspects of print production, receipt and distribution. 13. Performs related work as required.

WORKING ENVIRONMENT: Works in both the office and in the field.

JOB RELATIONSHIP: Supervised by: President

RISK EXPOSURE: Low Risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Business Development Manager…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein, and if employed as Business Development Manager, I will perform these duties to the best of my knowledge ability.

Date: / / Signature:

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Director of Therapy

JOB SUMMARY:

Directs the orientation, training, and supervising of physical therapy, occupational therapy and speech therapy services as well as the development of strategic objectives.

QUALIFICATIONS:

1. Is a licensed a licensed healthcare professional, or has experience and education in health service administration. 2. Is qualified by education, knowledge and experience to oversee the services provided. 3. Has at least two years healthcare or health service administration experience with at least one year of supervisory experience in home care or a closely related health program. 4. Has the appropriate education and experience as defined by the governing board/owner and any applicable state and federal laws and regulations. 5. Excellent verbal and written communication skills and strong interpersonal skills. 6. Knowledge of quality programming, process improvement strategies, and electronic medical records. 7. Knowledge of regulatory requirements at the federal, state and local levels, as well as knowledge of Agency policies and procedures. 8. At least 21 years of age.

LINE OF AUTHORITY: Reports to the Administrator.

RESPONSIBILITIES:

1. Accomplishes therapy human resource strategies by determining accountabilities; communicating and enforcing values, policies, and procedures; implementing recruitment, selection, orientation, training, coaching, counseling, disciplinary, and communication programs; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation strategies. 2. Develops therapy organizational strategies by contributing information, analysis, and recommendations to strategic thinking and direction; establishing functional objectives in line with organizational objectives. 3. Establishes therapy operational strategies by evaluating trends; establishing critical measurements; determining production, productivity, quality, and patient-service strategies; designing systems; accumulating resources; resolving problems; implementing change. 4. Develops therapy financial strategies by estimating, forecasting, and anticipating requirements, trends, and variances; aligning monetary resources; developing action plans; measuring and analyzing results; initiating corrective actions; minimizing the impact of variances. 5. Provides therapy services by evaluating patient care protocols; measuring outcomes; researching and evaluating emerging trends.

Job Description – Director of Therapy…continued Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

6. Assures therapy quality services by establishing and maintaining departmental quality assurance program including monitoring of quality indicators (treatment plans, daily notes, home programs), documenting actions taken to resolve problems, and reporting to the medical care evaluation committee in accordance with ACHC standards. 7. Provides therapist education programs as well as computer system training, as determined through the quality assurance program. 8. Provides academic and clinical experiences by maintaining liaison with area colleges; directing the clinical education program for therapy interns; and speaking at local colleges as requested. 9. Assists in establishing and maintaining referral relationships including physicians, hospitals, clinics, case management agencies and other referral sources. 10. Maintains legal and accreditation compliance by developing policy positions concerning federal, state, and local regulations, and ACHC standards; anticipating emerging issues. 11. Assists the business office with scheduling therapists to appropriate cases, as requested.

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

2. Supervised by: Administrator 3. Workers Supervised: Physical Therapists, Occupational Therapists, Speech Therapists

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Director of Therapy…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Director of Therapy, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Business Office Manager

JOB SUMMARY:

Oversees the administrative and quality functions related to medical records and related systems, admissions, discharges, billing, and insurance. Directly supervises the Medical Office Assistant, the Medical Records Specialist, the Intake Coordinator, and the Therapy Coordinator.

QUALIFICATIONS:

1. College degree or equivalent combination of education and experience directly related to the duties and responsibilities specified. 2. Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures. 3. Knowledge of professional clinical intake assessment and patient protocols and procedures. 4. Previous experience in the healthcare field and previous experience with automated information systems preferred. 5. Strong interpersonal and communication skills. 6. Ability to foster a cooperative work environment. 7. Knowledge of staff hiring procedures. 8. Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments. 9. Ability to communicate effectively, both orally and in writing. 10. Employee development and performance management skills. 11. Skill in organizing resources and establishing priorities. 12. Knowledge of budgeting, cost estimating, and fiscal management principles and procedures. 13. Ability to develop, maintain and manage record keeping systems and procedures.

LINE OF AUTHORITY: Reports to the agency Administrator.

RESPONSIBILITIES: 1. Manages and coordinates all aspects of patient intake, scheduling, insurance verification, reception, and patient medical records including ongoing physician orders. 2. Ensures staff obtain appropriate referrals and prior authorizations by third-party payers for services provided and billed; ensures that denials of claims are properly tracked, monitored, and resolved. 3. Oversees and coordinates the preparation and disposition of timely and accurate review and filing of medical treatment documentation. 4. Ensures compliance with standard and HIPPA policies relating to patient registration, billing, medical records, documentation, and transcription issues. 5. Establishes and implements short- and long-range organizational goals, objectives, policies, and operating procedures; monitors and evaluates operational effectiveness; effects changes required for improvement. 6. Oversees the supervision of personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance. 7. Recruiting, interviewing and hiring new internal office staff. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Business Office Manager…continued

8. Develops procedures and trains staff on new policies. 9. Develops and monitors office budgets, monitors resource utilization and initiates purchase requests. 10. Performs miscellaneous job-related duties as assigned.

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

1. Supervised by: Administrator 2. Workers Supervised: Administrative Support Specialist, Medical Records Specialist, Intake Coordinator, Therapy Services Coordinator.

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Business Office Manager…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Business Office Manager…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Business Office Manager, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Nursing Supervisor

JOB SUMMARY:

The Nursing Supervisor assists the Director of Nursing/Administrator with the supervision of home care services to patients in their place of residence and strives to provide the highest quality of care. The Nursing Supervisor (or qualified alternate) is available at all times during operating hours and participates in all activities relevant to the professional services furnished, including the development of qualifications and the assignment of personnel.

QUALIFICATIONS:

1. The skilled nursing and other therapeutic services furnished are under the supervision and direction of a physician or a registered nurse. 2. Two (2) years home health nursing experience, minimum. 3. One (1) year of supervisory experience required, two (2) years preferred. 4. Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing. 5. Acceptance of philosophy and goals of Agency. 6. Ability to exercise initiative and independent judgment. 7. Ability to work with individuals to enlist cooperation of many people to perform/achieve a common goal.

LINE OF AUTHORITY: Reports to the Director of Nursing/Administrator

RESPONSIBILITIES:

1. Understands and adheres to all applicable regulations, standards, and federal, state, and local laws and established Agency policies and procedures. 2. Participates in the development of standards which ensure safe and therapeutically effective service to patient/family. 3. Ability to supervise, guide and develop patient care personnel skills and performances. 4. Consults with the Director of Nursing/Administrator in determining a staffing pattern which will accomplish stated objectives and promote a maximum level of utilization of patient care personnel. 5. Assists in recruiting, hiring, evaluating and terminating personnel. Assists in instituting, interpreting and documenting disciplinary action. 6. Responsible for the orientation of new patient care personnel. 7. Assists in the planning and consultative needs of staff. 8. Assists in the preparation and implementation of policies and procedures which meet Medicare, Medicaid, Accrediting Organization (if applicable), and federal, state and local laws. 9. Displays a willingness to support policies and procedures and uses appropriate channels for changes of such policies. 10. Assists in the coordination of interdisciplinary team services.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Nursing Supervisor…continued

11. Assists in the organization of patient care services to delineate and delegate functional responsibility, lines of relationship and communication to provide safe and therapeutically effective service. 12. Participates in the coordination of Agency’s services with the services of other community agencies. 13. Participates in studies and research and other administrative functions as assigned. 14. Observes confidentiality and safeguards all patient related information. 15. Accepts responsibility for regular attendance and punctuality; fulfills job related requirements without regard to time involved. 16. Serves as a resource person to employees. 17. Develops a cooperative relationship and communicates effectively and professionally with physicians and referral sources. 18. Investigates and reports any problem relating to patient care and/or employee well-being. 19. Immediately reports any accident, incident, lost articles or unusual occurrence to the Director of Nursing/Administrator. 20. Attends pertinent continuing education programs other than routine in-services and shares information with staff. 21. Monitors equipment for appropriate use and takes steps to keep misuse to a minimum. 22. Assists with the Agency’s ongoing Quality Management (QM) program. 23. Assists with the development, implementation and evaluation of patient plans of care. 24. Reviews patient medical records for compliance with federal, state and local laws, Accrediting Organization standards (if applicable), and Agency policies and guidelines. 25. Assists Director of Nursing/Administrator in conducting patient care conferences, staff meetings and maintains documentation. Participates in community education projects. 26. Ensures that all necessary supplies and equipment are available. 27. Must be able to perform nursing functions in times of staff shortage. 28. Available to share on-call with nursing personnel as needed. 29. Ensures that documentation is completed in accordance with Agency policy. 30. Assists with staffing visit assignments and on-call. 31. Other duties as assigned by the Director of Nursing/Administrator. 32. Acts as Director of Nursing in the Director’s absence.

WORKING ENVIRONMENT:

Works indoors in Agency office and travels to/from patient homes.

JOB RELATIONSHIPS:

1. Supervised by: Director of Nursing/Administrator

WORKERS SUPERVISED: All patient care personnel.

RISK EXPOSURE: High risk

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Nursing Supervisor…continued

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Nursing Supervisor…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Nursing Supervisor, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Registered Nurse (RN)

JOB SUMMARY:

A Registered Nurse provides skilled nursing care to patients on an intermittent basis in their place of residence. Private duty nursing care may also be provided outside the home for activities of daily living. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Nursing/Nursing Supervisor.

QUALIFICATIONS:

1. Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing. 2. One (1) year nursing experience, preferred. 3. Acceptance of philosophy and goals of this Agency. 4. Ability to exercise initiative and independent judgment.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor

RESPONSIBILITIES:

1. Provides services in accordance with the physician plan of care. 2. Makes the initial evaluation visit and regularly reevaluates the patient’s nursing needs. 3. Initiates the plan of care and necessary revisions. 4. Furnishes those services requiring substantial specialized nursing skill. 5. Initiates appropriate preventive and rehabilitative nursing procedures. 6. Prepares clinical and progress notes for each patient visit and summaries of care conferences on patients in a timely manner as per Agency policy. 7. Coordinates services. 8. Promptly Informs physician and other personnel of changes in the patient’s condition and needs. 9. Counsels the patient and family/significant others in meeting nursing and related needs. 10. Participates in in-service programs, supervising and teaching other nursing personnel. 11. Understands and adheres to established Agency policies, procedures and current standards of practice. 12. Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries. 13. Assists in determining the amount and type of nursing needed by each individual patient. 14. Refers to Physical Therapist, Speech Language Pathologist, Occupational Therapist and Medical Social Worker for those patients requiring their specialized skills. 15. Supervises the LPN every 30-days and teaches, orients, trains other nursing personnel, when requested. 16. Conducts patient care conferences on patients assigned to his/her care. 17. Participates in peer review and quality management as assigned. 18. Participates in utilization review of medical records as assigned. 19. Takes on-call duty nights, weekends and holidays, as assigned.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Registered Nurse…continued

20. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames, as needed depending on age of patient. 21. Appropriately utilizes ICD-9 diagnoses and codes. 22. Observes confidentiality and safeguards all patient related information. 23. Attends staff meetings and patient care conferences as scheduled. 24. Completes documentation and paperwork in a timely manner per Agency policy. 25. Immediately reports to Director of Nursing/Nursing Supervisor and physician any patient incidents/variances or complaints. 26. Demonstrates competent performance of technical skills according to established procedures. 27. Understands and adheres to established policies/procedures and accepted current standards of practice. 28. Adheres to Agency standards when performing all assigned responsibilities. 29. Maintains acceptable attendance status, per Agency policy. 30. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor. 31. Appearance is always within Agency standard; is clean, well groomed and dressed appropriately for the clinical work environment. 32. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 33. Maintains clean and neat work environment. 34. Demonstrates sound judgment, critical thinking and decision making. 35. Maintains current CPR certification from a certified provider. (no online CPR accepted) 36. Performs other duties as assigned/requested.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes. May provide care outside the home for activities of daily living. Examples include school and medical appointments.

JOB RELATIONSHIPS:

1. Supervised by: Director of Nursing/Nursing Supervisor

2. Workers Supervised: Licensed Practical Nurse and other registered nurses, when requested.

RISK EXPOSURE:

High risk

PHYSICAL REQUIREMENTS:

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Job Description – Registered Nurse…continued

PHYSICAL DEMANDS WORK ENVIRONMENT On-the-job time is spent in the following physical activities. This job requires exposure to the following environmental conditions. Show the amount of time by checking the appropriate boxes below. Show the amount of time by checking the appropriate boxes below.

None Up to 1/3 1/3 None Up 1/3 2/3 1/3 to ½ and to to and more 1/3 1/2 more Stand √ Wet, humid conditions (non-weather) √ Walk √ Work near moving mechanical parts (vents) √ Sit √ Fumes or airborne particles (nebs/oxygen) √ Talk or hear √ Toxic or caustic chemicals √ Use hands to finger, handle or feel √ Outdoor weather conditions √ Push/pull √ Extreme cold (non-weather) √ Stoop, kneel, crouch or crawl √ Extreme heat (non-weather) √ Reach with hands and arms √ Risk of electrical shock (vent/humidifer) √ Taste or smell √ Work with explosives (oxygen) √ Risk of radiation √ Vibration (CPT Vest) √ This job requires that weight be lifted or force be exerted. Show how much & how often by checking the appropriate boxes below None Up to 1/3 2/3 The typical noise level for the environment for the work environment is: (Check 1/3 to ½ and all that apply) more Up to 10 pounds √  Very Quiet  Loud Noise  Quiet Up to 25 pounds √  Moderate Noise  Very Loud Noise Up to 50 pounds √ Up to 100 pounds √ Hearing: More than 100 pounds √  Ability to hear alarms on equipment  Ability to hear patient call  Ability to hear instructions from staff

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+ √ Close vision (clear vision at 20 inches or less) – dressing/trach changes Right only √  Distance Vision (clear vision at 20 feet or more) Left only √ Color Vision (ability to identify and distinguish colors) - blue vs pale Both  Peripheral Vision Repetitive use of Hands  Depth Perception Right only √ Ability to Adjust Focus (night time/pale light) Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Registered Nurse…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Registered Nurse, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Licensed Practical (Vocational) Nurse (LPN/LVN))

JOB SUMMARY:

A qualified Licensed Practical (Vocational) Nurse provides skilled nursing care to patients on an intermittent basis in their place of residence. Private duty nursing care may also be provided outside the home for activities of daily living. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Registered Nurse. Services are furnished in accordance with Agency policies.

QUALIFICATIONS:

1. Graduate of an approved school of practical (vocational) nursing and currently licensed in the state(s) in which practicing. 2. Minimum of one (1) year experience in nursing, preferred. 3. Acceptance of philosophy and goals of this Agency. 4. Ability to exercise initiative and independent judgment.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor/RNs

RESPONSIBILITIES:

1. Furnishes services, treatments and diagnostic and preventive procedures as assigned per the plan of care, in accordance with agency policies. 2. Prepares clinical and progress notes. 3. Assists the physician, the intermediate care provider and RN in performing specialized procedures. 4. Prepares equipment and materials for treatments observing aseptic technique as required and when delegated. 5. Assists the patient in learning appropriate self-care techniques. 6. Understands and adheres to established policies, procedures and current standards of practice. 7. Implements the nursing care plan for each patient. 8. Initiates preventive and rehabilitative nursing procedures as appropriate. 9. Observes signs and symptoms and promptly reports to the physician and registered nurse reactions to treatments, including drug reactions and changes in the patient's physical or emotional condition. 10. Teaches and counsels the patient and family/significant others regarding the nursing care needs and other related problems of the patient at home. 11. Evaluates with registered nurse the effectiveness of the LPN/LVN's nursing service to the patient and family under the guidance of the registered nurse. 12. Maintains accurate and complete records of observations, treatments and care of patient. 13. Attends staff meetings, patient care conferences and in-services as scheduled. 14. Takes on-call duty, nights, weekends and holidays as assigned. 15. Submits any changes in schedule to Director of Nursing/Nursing Supervisor/ Registered Nurse on a daily basis.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – LPN/LVN…continued

16. Participates in patient care conferences to discuss the need for involvement of other members of the health team, such as physical therapist or speech language pathologist. 17. Accepts, writes and executes orders; orders are cosigned by RN. 18. Assures that the patient/family is involved in implementing the plan of care. 19. Assists in reviewing, evaluating and updating the patient plan of care as appropriate. 20. Administers medications and treatments as ordered. 21. Provides appropriate information regarding patient to other agencies/ individuals involved in patient's care as needed, while observing confidentiality requirements. 22. Observes confidentiality and safeguards all patient related information. 23. Completes documentation and paperwork in a timely manner as per Agency policy. 24. Immediately reports to Director of Nursing/Nursing Supervisor/RN any patient incidents/variances or complaints. 25. Demonstrates competent performance of technical skills according to established procedures before performing new skills. 26. Participates in peer review, QM, utilization review, and medical record audit activities as assigned. 27. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 28. Maintains acceptable attendance status, per Agency policy. 29. Reports all incomplete work assignments to Nursing Supervisor/RN. 30. Appearance is always within Agency standards; is clean, well groomed and dressed appropriately for clinical work environment. 31. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 32. Participates in in-service education programs as assigned. 33. Maintains clean and neat work environment. 34. Demonstrates sound judgment, critical thinking and decision making. 35. Maintains current CPR certification by a certified provider (no online CPR accepted). 36. Performs other duties as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes. May provide care outside the home for activities of daily living. Examples include school and medical appointments.

JOB RELATIONSHIPS:

1. Supervised by: Director of Nursing/Nursing Supervisor/RNs

RISK EXPOSURE: High risk

PHYSICAL REQUIREMENTS:

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Job Description – LPN/LVN…continued

None Up to 1/3 1/3 None Up 1/3 2/3 1/3 to ½ and to to and more 1/3 1/2 more Stand √ Wet, humid conditions (non-weather) √ Walk √ Work near moving mechanical parts (vent) √ Sit √ Fumes or airborne particles (neb/oxygen) √ Talk or hear √ Toxic or caustic chemicals √ Use hands to finger, handle or feel √ Outdoor weather conditions √ Push/pull √ Extreme cold (non-weather) √ Stoop, kneel, crouch or crawl √ Extreme heat (non-weather) √ Reach with hands and arms √ Risk of electrical shock – vent/humidifier √ Taste or smell √ Work with explosives – Oxygen √ Risk of radiation √ Vibration – CPT Vest √ This job requires that weight be lifted or force be exerted. Show how much & how often by checking the appropriate boxes below None Up to 1/3 2/3 The typical noise level for the environment for the work environment is: (Check 1/3 to ½ and all that apply) more Up to 10 pounds √  Very Quiet  Loud Noise  Quiet Up to 25 pounds √  Moderate Noise  Very Loud Noise Up to 50 pounds √ Up to 100 pounds √ Hearing: More than 100 pounds √  Ability to hear alarms on equipment  Ability to hear patient call  Ability to hear instructions from staff

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+ √ Close vision (clear vision at 20 inches or less) dressing/trach change Right only √  Distance Vision (clear vision at 20 feet or more) Left only √ Color Vision (ability to identify and distinguish colors) Both  Peripheral Vision Repetitive use of Hands  Depth Perception Right only √ Ability to Adjust Focus (night time/pale light) Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – LPN/LVN…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Licensed Practical (Vocational) Nurse, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Medical Social Worker (MSW)

JOB SUMMARY:

A Medical Social Worker (MSW) provides social work services to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Nursing/Nursing Supervisor. Services are furnished by a qualified social worker or by a qualified social work assistant under the supervision of a qualified social worker.

QUALIFICATIONS:

1. A person who has a master’s degree from a school of social work accredited by the Council on Social Work Education, and has one year experience in a health care setting, or 2. Has a baccalaureate degree in social work, psychology, sociology or other field related to social work, and has had at least one year experience in a health care setting (functions as an assistant). 3. Licensed by Colorado Division of Registrations. 4. Three to five (3-5) years’ experience, preferred. 5. One (1) year experience in home care, preferred. 6. Acceptance of philosophy and goals of Agency. 7. Ability to exercise initiative and independent judgment. 8. Ability to work with individuals to enlist cooperation of many people to perform/achieve a common goal.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor

RESPONSIBILITIES: 1. Assists physician, or intermediate care provider, and other team members in understanding the significant social and emotional factors related to the health problems. 2. Participates in the development of the plan of care. 3. Prepares clinical and progress notes. 4. Works with the family. 5. Participates in the coordination of Agency's services with the services of other community resources; uses community resources. 6. Participates in discharge planning. 7. Participates in in-services and/or continuing education programs. 8. Acts as a consultant to other Agency personnel. 9. Understands and adheres to established Agency policies/procedures. 10. Observes confidentiality and safeguards all patient information. 11. Serves as a resource person to employees, patients, physicians and other allied healthcare providers. 12. Develops a cooperative relationship and communicates effectively and professionally with physicians. 13. Immediately reports any accident, incident, lost articles or unusual occurrence to Director of Nursing/Nursing Supervisor. 14. Participates in staff meetings and patient care conferences as scheduled. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – MSW…continued

15. Maintains contact with community support groups and provides professional expertise as required. 16. Plans/coordinates social services within the Agency. 17. Promotes community awareness of services provided. 18. Participates in the development of the plan of care; ensures that the patient plan of care includes identified problems, interventions and goals. 19. Participates in community activities and facilitates community awareness and support. 20. Provides psychosocial services in accordance with established standards. 21. Evaluates quality of psychosocial services provided. 22. Informs the RN of changes in the patient's condition and needs. 23. Schedules patient visits as necessary according to patient needs and as physician orders. 24. Observes confidentiality and safeguards all patient related information. 25. Attends staff meetings and patient care conferences as scheduled. 26. Completes documentation and paperwork in a timely manner as per Agency policy; prepares clinical and progress notes. 27. Participates in peer review and QM activities as requested. 28. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 29. Maintains acceptable attendance status, per Agency policy. 30. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor. 31. Appearance is always within Agency standards; is clean and well groomed. 32. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 33. Maintains clean and neat work environment. 34. Demonstrates sound judgment and decision making. 35. Maintains current CPR certification. 36. Performs other duties as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes.

JOB RELATIONSHIPS:

Supervised by: Director of Nursing/Nursing Supervisor/Peer Social Worker

RISK EXPOSURE: High risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – MSW…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – MSW…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Medical Social Worker, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Physical Therapist (PT)

JOB SUMMARY:

A Physical Therapist (PT) administers physical therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Nursing/Nursing Supervisor.

QUALIFICATIONS: 1. Graduate from a physical therapy curriculum approved by the American Physical Therapy Association, or the Committee on Allied Health Education and Accreditation of the American Medical Association, or the Council of Medical Education of the American Medical Association and American Physical Therapy Association. 2. Currently licensed in the state(s) in which practicing. 3. Two (2) years experience, preferred. 4. Acceptance of philosophy and goals of the Agency. 5. Ability to exercise initiative and independent judgment.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor/ Therapy Supervisor

RESPONSIBILITIES: 1. Assists the physician or intermediate care provider in evaluating level of function, helps develop the plan of care and revise as necessary. 2. Prepares clinical and progress notes. 3. Advises and consults with the family and other agency personnel. 4. Participates in in-service programs and presents in-service programs as assigned. 5. Understands and adheres to established policies and procedures. 6. Participates with all other health care personnel in patient care planning. 7. Directs and supervises assistant (PTA) personnel as required. 8. Completes initial history and evaluation visit, notifies physician of patient needs and submits plan of care and orders for physician approval. 9. Performs all skilled physical therapy procedures as ordered by physician. 10. Consults with physicians regarding change in treatment. 11. Writes reports to physicians regarding patient's progress. 12. Instructs patients and family/significant others in home programs and activities of daily living. 13. Attends all staff meetings and patient care conferences as scheduled. 14. Supervises the PTA every 30-days as assigned. 15. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. 16. Appropriately utilizes ICD-9 diagnoses and codes. 17. Directs and supervises performance of PTA as indicated. 18. Completes a discharge summary upon completion of therapy services. 19. Completes a recertification for physician every 60 days if further treatment is to be continued. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – PT…continued

20. Instruction to patient/family in home program with documentation in medical record notes. 21. Observes confidentiality and safeguards all patient related information. 22. Prepares and submits patient evaluations, clinical and progress notes in a timely manner as outlined in Agency policy. 23. Immediately reports to Director of Nursing/Nursing Supervisor/RN any patient incidents/variances or complaints. 24. Participates in peer review and QM activities as requested. 25. Participates in utilization review of medical records as assigned. 26. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 27. Maintains acceptable attendance status, per Agency policy. 28. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor/Therapy Supervisor. 29. Appearance is always within Agency standards; is clean and well groomed. 30. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 31. Maintains clean and neat work environment. 32. Demonstrates sound judgment, critical thinking and decision making. 33. Maintains current CPR certification. 34. Performs other duties as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes.

JOB RELATIONSHIP:

1. Supervised by: Director of Nursing/Nursing Supervisor/Therapy Supervisor/Peer PT

2. Workers Supervised: Physical Therapy Assistant

RISK EXPOSURE: High risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – PT…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – PT…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Physical Therapist, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Physical Therapy Assistant (PTA)

JOB SUMMARY:

A Physical Therapy Assistant (PTA) administers physical therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Physical Therapist (PT).

QUALIFICATIONS:

1. Have completed a physical therapy assistant program accredited by the commission on accreditation in physical therapy or any comparable successor entity; or has graduated from a 2-year college-level program approved by the American Physical Therapy Association. 2. Currently licensed in the state(s) in which practicing, or be registered, licensed or certified in another state; or be otherwise qualified to take the physical therapy assistant examination. 3. Two (2) years experience, preferred. 4. Acceptance of philosophy and goals of Agency. 5. Ability to exercise initiative and independent judgment.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor/ Therapy Supervisor/Supervising Physical Therapist

RESPONSIBILITIES:

1. Performs services planned, delegated and supervised by the Physical Therapist. 2. Assists in preparing clinical and progress notes. 3. Participates in educating the patient and family. 4. Participates in in-service programs and presents in-service programs as assigned. 5. Understands and adheres to established Agency policies and procedures. 6. Provides physician prescribed physical therapy under a written plan of care established by the PT. 7. Participates with all other health care personnel in patient care planning. 8. Consults with PT regarding change in treatment. 9. Instructs patients and family members in home programs and activities of daily living. 10. Attends all staff meetings and patient care conferences as scheduled. 11. Prepares medical records, progress notes and updates care plans for each patient visit in a timely manner as per Agency policy. 12. Informs the PT and other team members of changes in the patient's condition and needs. 13. Continually reevaluates needs of patient/family. 14. Coordinates the therapy aspects of patient care with the PT. 15. Consults with PT to determine whether treatment plan should be continued, changed or terminated. 16. Instruction to patient/family in home program with documentation in medical record notes. 17. Observes confidentiality and safeguards all patient related information. 18. Completes and submits progress notes and paperwork in a timely manner per Agency policy. 19. Immediately reports to supervising Physical Therapist any patient incidents/variances or complaints.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – PTA…continued

20. Demonstrates competent performances of technical skills according to established procedures. 21. Participates in peer review and QM activities as requested. 22. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 23. Maintains acceptable attendance status, per Agency policy. 24. Reports all incomplete work assignments to supervising Physical Therapist. 25. Appearance is always within Agency standards; is clean and well groomed. 26. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 27. Maintains clean and neat work environment. 28. Demonstrates sound judgment and decision making. 29. Maintains current CPR certification. 30. Performs other duties as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes.

JOB RELATIONSHIP:

1. Supervised by: Director of Nursing/Nursing Supervisor/ Therapy Supervisor/Supervising Physical Therapist

RISK EXPOSURE: High risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – PTA…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – PTA…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Physical Therapy Assistant, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Occupational Therapist (OT)

JOB SUMMARY:

An Occupational Therapist (OT) administers occupational therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Nursing/Nursing Supervisor/Therapy Supervisor.

QUALIFICATIONS:

1. Graduate of an Occupational Therapy curriculum accredited jointly by the Committee on Allied Health Education and Accreditation of the American Medical Association and the American Occupational Therapy Association (AOTA) and/or certified by successfully completing the National Certification examination, or 2. Is eligible for the National Registration Examination of the American Occupational Therapy Association. 3. Two (2) years experience, preferred.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor/ Therapy Supervisor

RESPONSIBILITIES:

1. Assists the physician or intermediate care provider in evaluating level of function, helps develop the plan of care and revise as necessary. 2. Prepares clinical and progress notes. 3. Advises and consults with the family and other agency personnel. 4. Participates in in-service programs and presents in-service programs as assigned. 5. Understands and adheres to established policies and procedures. 6. Participates with all other health care personnel in patient care planning. 7. Directs and supervises assistant (COTA) personnel as required. 8. Completes initial history and evaluation visit, notifies physician of patient needs and submits plan of care and orders for physician approval. 9. Performs all skilled occupational therapy procedures as ordered by physician. 10. Consults with physicians regarding change in treatment. 11. Writes reports to physicians regarding patient's progress. 12. Instructs patients and family/significant others in home programs and activities of daily living. 13. Attends all staff meetings and patient care conferences as scheduled. 14. Supervises the COTA every 30-days as assigned. 15. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. 16. Appropriately utilizes ICD-9 diagnoses and codes. 17. Directs and supervises performance of COTA as indicated. 18. Completes a discharge summary upon completion of therapy services.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – OT…continued

19. Completes a recertification for physician every 60 days if further treatment is to be continued. 20. Instruction to patient/family in home program with documentation in medical record notes. 21. Observes confidentiality and safeguards all patient related information. 22. Prepares and submits patient evaluations, clinical and progress notes in a timely manner as outlined in Agency policy. 23. Immediately reports to Director of Nursing/Nursing Supervisor/RN any patient incidents/variances or complaints. 24. Participates in peer review and QM activities as requested. 25. Participates in utilization review of medical records as assigned. 26. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 27. Maintains acceptable attendance status, per Agency policy. 28. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor/Therapy Supervisor. 29. Appearance is always within Agency standards; is clean and well groomed. 30. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 31. Maintains clean and neat work environment. 32. Demonstrates sound judgment, critical thinking and decision making. 33. Maintains current CPR certification. 34. Performs other duties as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes.

JOB RELATIONSHIP:

1. Supervised by: Therapy Supervisor/Peer OT

2. Workers Supervised: COTA as assigned

RISK EXPOSURE:

High risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – OT…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – OT…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as an Occupational Therapist, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Certified Occupational Therapy Assistant (COTA) JOB SUMMARY: A Certified Occupational Therapy Assistant (COTA) administers occupational therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Occupational Therapist and Director of Nursing/Nursing Supervisor/Therapy Supervisor. QUALIFICATIONS: 1. At a minimum, a COTA must possess a current certification from the National Board for Certification of Occupational Therapy (NBOT). 2. Two (2) years experience, preferred. LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor/ Therapy Supervisor/Supervising Occupational Therapist RESPONSIBILITIES: 1. Performs services planned, delegated and supervised by the Occupational Therapist. 2. Assists in preparing clinical and progress notes. 3. Participates in educating the patient and family. 4. Participates in in-service programs and presents in-service programs as assigned. 5. Understands and adheres to established Agency policies and procedures. 6. Provides physician prescribed occupational therapy under a written plan of care established by the OT. 7. Participates with all other health care personnel in patient care planning. 8. Consults with OT regarding change in treatment. 9. Instructs patients and family members in home programs and activities of daily living. 10. Attends all staff meetings and patient care conferences as scheduled. 11. Prepares medical records, progress notes and updates care plans for each patient visit in a timely manner as per Agency policy. 12. Informs the OT and other team members of changes in the patient's condition and needs. 13. Continually reevaluates needs of patient/family. 14. Coordinates the therapy aspects of patient care with the OT. 15. Consults with OT to determine whether treatment plan should be continued, changed or terminated. 16. Instruction to patient/family in home program with documentation in medical record notes. 17. Observes confidentiality and safeguards all patient related information. 18. Completes and submits progress notes and paperwork in a timely manner per Agency policy. 19. Immediately reports to supervising Occupational Therapist any patient incidents/variances or complaints. 20. Demonstrates competent performances of technical skills according to established procedures. 21. Participates in peer review and QM activities as requested. 22. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 23. Maintains acceptable attendance status, per Agency policy.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – COTA…continued

24. Reports all incomplete work assignments to supervising Occupational Therapist. 25. Appearance is always within Agency standards; is clean and well groomed. 26. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 27. Maintains clean and neat work environment. 28. Demonstrates sound judgment and decision making. 29. Maintains current CPR certification. 30. Performs other duties as assigned. WORKING ENVIRONMENT: Works indoors in Agency office and patient homes and travels to/from patient homes. JOB RELATIONSHIP: 1. Supervised by: Director of Nursing/Nursing Supervisor/Therapy Supervisor/ Supervising Occupational Therapist RISK EXPOSURE: High risk PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – COTA…continued

None Up 1/3 1/3 None Up 1/3 2/3 to to ½ and to to and 1/3 more 1/3 1/2 more Stand √ Wet, humid conditions (non-weather) √ Walk √ Work near moving mechanical parts √ Sit √ Fumes or airborne particles √ Talk or hear √ Toxic or caustic chemicals √ Use hands to finger, handle √ Outdoor weather conditions √ or feel Push/pull √ Extreme cold (non-weather) √ Stoop, kneel, crouch or crawl √ Extreme heat (non-weather) √ Reach with hands and arms √ Risk of electrical shock √ Taste or smell √ Work with explosives √ Risk of radiation √ Vibration √ This job requires that weight be lifted or force be exerted. Show how much & how often by checking the appropriate boxes below None Up 1/3 2/3 The typical noise level for the environment for the work environment to to ½ and is: (Check all that apply) 1/3 more Up to 10 pounds √  Very Quiet  Loud Noise  Quiet Up to 25 pounds √  Moderate Noise  Very Loud Noise Up to 50 pounds √ Up to 100 pounds √ Hearing: More than 100 pounds √  Ability to hear alarms on equipment  Ability to hear patient call Ability to hear instructions from physician/department staff

Job Description – COTA…continued

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Job Description – COTA…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Certified Occupational Therapy Assistant, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Speech Language Pathologist (SLP)

JOB SUMMARY:

A Speech Language Pathologist (SLP) administers speech therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Nursing/Nursing Supervisor/Therapy Supervisor. Speech therapy services are furnished only by or under the supervision of a qualified speech pathologist or audiologist.

QUALIFICATIONS:

1. A person who possesses a certificate of Clinical Competency in Speech Pathology or Audiology granted by the American Speech-Language Hearing Association, or 2. A person who meets the educational requirements for certification and is in the process of accumulating the supervised experience required for certification. 3. Two (2) years experience, preferred.

LINE OF AUTHORITY: Reports to the Director of Nursing/Nursing Supervisor/ Therapy Supervisor

RESPONSIBILITIES:

1. Assists the physician or intermediate care provider in evaluating level of function, helps develop the plan of care and revise as necessary. 2. Prepares clinical and progress notes. 3. Advises and consults with the family and other agency personnel. 4. Participates in in-service programs and presents in-service programs as assigned. 5. Understands and adheres to established policies and procedures. 6. Participates with all other health care personnel in patient care planning. 7. Completes initial history and evaluation visit, notifies physician of patient needs and submits plan of care and orders for physician approval. 8. Performs all skilled Speech Language Pathology services as ordered by physician. 9. Consults with physicians regarding change in treatment. 10. Writes reports to physicians regarding patient's progress. 11. Instructs patients and family/significant others in home programs. 12. Attends all staff meetings and patient care conferences as scheduled. 13. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. 14. Appropriately utilizes ICD-9 diagnoses and codes. 15. Completes a discharge summary upon completion of therapy services. 16. Completes a recertification for physician every 60 days if further treatment is to be continued. 17. Instruction to patient/family in home program with documentation in medical record notes. 18. Observes confidentiality and safeguards all patient related information.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – SLP…continued

19. Prepares and submits patient evaluations, clinical and progress notes in a timely manner as outlined in Agency policy. 20. Immediately reports to Director of Nursing/ Supervisor any patient incidents/ variances or complaints. 21. Participates in peer review and QM activities as requested. 22. Participates in utilization review of medical records as assigned. 23. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. 24. Maintains acceptable attendance status, per Agency policy. 25. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor/Therapy Supervisor. 26. Appearance is always within Agency standards; is clean and well groomed. 27. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. 28. Maintains clean and neat work environment. 29. Demonstrates sound judgment, critical thinking and decision making. 30. Maintains current CPR certification. 31. Performs other duties as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes.

JOB RELATIONSHIP:

1. Supervised by: Director of Nursing/Nursing Supervisor/Therapy Supervisor/Peer SLP

RISK EXPOSURE: High risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – SLP…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – SLP…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Speech Language Pathologist, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Intake Coordinator

JOB SUMMARY: The Intake Coordinator receives all referrals requesting RN and therapy services. This RN performs an initial screening to determine suitability for admission to Home Health Care according to Medicaid and third party payer guidelines. This RN works with the therapy coordinator to ensure patients are staffed after receiving orders from the admitting physician. This RN communicates all financial information to Billing and Clinical Staff. This RN is responsible for communication of the patients’ status to the clinical staff regarding therapy cases prior to the resumption of care after orders are received from the patients’ physician. QUALIFICATIONS:

1. Licensed RN 2. Computer literate with the ability to learn customer service software applications 3. Professionally skilled in verbal and written communications 4. Strong interpersonal skills 5. Handles difficult situations directly, using appropriate discretion and respect for the individual. 6. Bilingual preferred, although not required 7. Meticulously organized in approach to medical record reviews 8. Detail oriented 9. Occasional travel may be required 10. Highly dependable with excellent follow through skills 11. Team player

LINE OF AUTHORITY: Reports to the Business Office Manager.

RESPONSIBILITIES:

1. This position integrates the PPHC Mission, Vision, and Values into each of the responsibilities of this job and daily communication with customers and co-workers. 2. This position adheres to and is responsible for following the established quality performance standards in accordance with regulatory requirements. 3. This position actively maintains confidentiality for our patients and their families as outlined in the PPHC Patient Confidentiality Policy and shows the same level of respect for every Associate with in PPHC. 4. Provides telephone intake of information relating to patient referrals. 5. Gets H&P from physician regarding care needs. 6. Determines appropriateness of referral to home care based on established criteria. 7. Disseminates the intake information to appropriate sources. 8. Obtains/receives initial physician and change orders. 9. Enters referral and other appropriate information into the computer 10. Provides follow up regarding the start of services and patient satisfaction. 11. Obtains, reviews, and enters the provider specific care plans and goals into the initial physician order upon receipt. 12. Obtains initial authorization for services on Medicaid patients. Job Description – Intake Coordinator…continued Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

13. Participates in the medication review process for all clinical records. 14. Assists Supervisory team with other duties as needed. 15. Attend in-services and continuing education programs when appropriate and assigned. Remain current on innovations, developments, new procedures, and techniques in nursing care as it may pertain to clinical referral information. 16. Actively participates in system development and supports staff participation throughout the department. 17. Performs other duties as assigned.

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

4. Supervised by: Business Office Manager

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Job Description – Intake Coordinator…continued Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein, and if employed as an Intake Coordinator, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Therapy Coordinator JOB SUMMARY:

The Therapy Coordinator is responsible for the receipt of and assignment of new patient referrals, add on services, and therapy reassignment.

QUALIFICATIONS:

1. High School diploma or GED and two years experience in scheduling home health care services required. Closely related medical experience and training or equivalent combination may be substituted. 2. Requires intermediate computer skills (Microsoft Office Outlook/Excel). 3. Typing skills with a Minimum of 45 wpm. 4. Must possess excellent human relations, customer service, organizational skills, and attention to detail. 5. Must be able to work well in a team and under time pressures. 6. The position requires managing multiple demands simultaneously each day. 7. Excellent telephone etiquette and communication skills are necessary.

LINE OF AUTHORITY: Reports to the Business Office Manager.

RESPONSIBILITIES:

1. Receives patient therapy referrals 2. Assigns therapists to cases based on specialty and area. 3. Verifies eligibility for Medicaid services. 4. Gives private insurance referrals to billing for private insurance intake. 5. Informs billing manager of any add on services for private insurance authorization 6. Receives verbal and/or written orders from primary care physician. 7. Sends consent packages to families and follows up to ensure consent is received. 8. Follows up with therapists to ensure services are being met. 9. Sets up coordination of care plan and documentation for outside disciplines. 10. Reassigns therapists and adds therapy services as needed. 11. Communicates with therapists in a prompt, courteous, and helpful manner. 12. Works with other PPHC internal staff regarding therapist needs 13. Updates demographic, insurance and other necessary information in the computer records as needed. 14. Assists with the answering of the telephone, screens calls, take messages, and provides information along with greeting patients in a prompt, courteous and helpful manner. 15. Computer data entry of patient health information and/or typing of correspondence and documents. 16. Uses computer system to add and distribute information to the patient electronic record or other appropriate sources. 17. Creates and faxes requested information. 18. Copies, sorts, and assembles documents as needed. 19. Ensure all communications reflect the standards and mission of PPHC. 20. Maintains patient confidentiality and follows HIPAA Guidelines.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Therapy Coordinator…continued

21. Display a consistently positive, cooperative, self-motivated, courteous and professional attitude. 22. Performs other duties as assigned

WORKING ENVIRONMENT: Works indoors in agency JOB RELATIONSHIPS:

1. Supervised by: Reports to the Business Office Manager.

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Therapy Coordinator…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only √  Distance Vision (clear vision at 20 feet or more) Left only √  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Therapy Coordinator…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as Therapy Coordinator, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Medical Record Support Specialist

JOB SUMMARY:

Medical Record Support Specialist will be primarily responsible for ensuring quality of the patient therapy records.

QUALIFICATIONS: 1. Strong knowledge of Microsoft Office Programs (Word, Excel, Access) and general computer skills 2. Ability to use basic office equipment (computer, emailing, phone system including voice mail, fax machine, copy machine, and postage machine) 3. Proficient typing skills and spelling skills 4. Strong organizational skills and attention to detail 5. Ability to prioritize and multi-task 6. Exceptional customer-oriented demeanor and phone skills 7. Problem Solving Skills 8. 18 years of age, minimum 9. High School Diploma or GED, College degree preferred

LINE OF AUTHORITY: Reports to the Business Office Manager

RESPONSIBILITIES: 1. Maintain Access Database through Data Entry. Includes but not limited to maintenance and tracking of therapists’ “Plan of Care’s”, communication updates, address changes, and other patient record changes. 2. Review of Therapist’s Plan of Care Records for compliance purposes (checklist of items to review are provided) 3. Updating of therapy orders on 485 document, as needed 4. Review of patient therapy records for quality control measures at 60 day recertification renewal. (Checklist) 5. Track Physician Order renewal dates and print out of physician orders through the database system for clinical director review 6. Track Medicaid Prior Authorizations Requests (PAR) through database system and prepare new authorizations when needed. 7. Ability to request needed information from therapist’s and interact with therapists in a courteous manner 8. Use of Email to communicate information to office personnel as necessary Secondary/Back Up Responsibilities (if needed): 9. Answer and direct phone inquiries through phone system management in a courteous manner, as needed. Includes transfer of calls and transferring to voice mail 10. Assist in processing of incoming mail and checking in of therapy billing, as needed 11. Faxing of Medical Records to Physician Offices, as needed 12. Filing of Medical Records in patient charts, as needed 13. Mail out physician orders (including addressing, return envelope and applying postage) provided by clinical director, as needed

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Medical Record Support Specialist…continued

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

5. Supervised by: Business Office Manager

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Medical Record Support Specialist…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Medical Record Support Specialist, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Medical Administrative Assistant

JOB SUMMARY:

Provide administrative support to Agency. Duties include general clerical, receptionist and project based work. Project a professional company image through in-person and phone interaction.

QUALIFICATIONS:

1. Strong knowledge of Microsoft Office Programs (Word, Excel, Access) and general computer skills 2. Ability to use basic office equipment (computer, emailing, phone system including voice mail, fax machine, scanner, copy machine, and postage machine) 3. Proficient typing skills and spelling skills 4. Strong organizational skills and attention to detail 5. Ability to prioritize and multi-task 6. Exceptional customer-oriented demeanor and phone skills 7. Problem Solving Skills 8. Minimum High School Diploma or GED. College Degree preferred.

LINE OF AUTHORITY: Reports to the Training and Documentation Manager

RESPONSIBILITIES:

1. Understand and adhere to established Agency policies and procedures. 2. Answer and direct phone inquiries through phone system management in a courteous manner. Includes transfer of calls and transferring to voice mail 3. Assist in processing incoming mail including checking in billing statements and matching to therapy notes. 4. Assist in transition of paper medical records to electronic system 5. Use of Email to communicate information to office personnel as necessary 6. Faxing and uploading of Medical Records to Physician Offices 7. Filing and scanning of Medical Records as assigned, either paper or electronically 8. Follow up on receipt of physician orders provided by clinical personnel 9. Maintain and track new patient consent packages 10. Maintain, Track, and Order Office Supplies on a monthly basis 11. Project management which includes but not limited to in-service training support and annual satisfaction survey mailing and tracking

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Medical Administrative Assistant…continued

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

6. Supervised by: Training and Documentation Manager

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Medical Administrative Assistant…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Medical Administrative Assistant, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Billing Authorization Manager JOB SUMMARY:

The Billing Authorization Manager will oversee all functions related to the patient eligibility, authorization, reconciliation, and follow up of payments for all private insurance and private pay claims.

QUALIFICATIONS:

1. Good problem solving, organizational skills and attention to detail. 2. Ability to prioritize and multi-task 3. Exceptional customer-oriented demeanor and phone skills 4. Strong knowledge of Microsoft Office Programs (Word, Excel, Access) and general computer skills

LINE OF AUTHORITY: Reports to the Business Office Manager

RESPONSIBILITIES:

1. Receive private insurance information from office staff on new patients. 2. Verifies private insurance eligibility upon start and at least annually thereafter. 3. Initiates authorization of services and visit span. 4. Requests new authorizations as needed. 5. Provides clinical information upon request. 6. Receives and bills monthly private insurance billing dates, which also includes secondary billing as needed. 7. Sends out invoices for private pays, co-pays, and deductibles. 8. Private insurance claim follow up and resubmission as needed. 9. Assists clients with grants and other funding access. 10. Other duties and projects, as needed.

WORKING ENVIRONMENT: Works indoors

JOB RELATIONSHIPS:

1. Supervised by:

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Billing Authorization Manager…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as Billing Authorization Manager, I will perform these duties to the best of my knowledge and ability. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Payroll/Human Resources Assistant

JOB SUMMARY:

Responsible for payroll and benefit management in accordance to Agency policies, procedures, and accounting principles. May also provide support in other areas functional areas of human resources including documentation tracking for personnel records, job evaluations, orientation, supervision, and training as needed.

QUALIFICATIONS:

1. Strong knowledge of Microsoft Office Programs (Word, Excel, Access) and general computer skills 2. Ability to use basic office equipment (computer, emailing, phone system including voice mail, fax machine, copy machine, and postage machine) 3. Strong organizational skills and attention to detail 4. Strong math skills 5. Ability to prioritize and meet deadlines 6. Exceptional customer-oriented demeanor and phone skills 7. Problem Solving Skills 8. Minimum 2 year College Degree

LINE OF AUTHORITY: Reports to the Controller

RESPONSIBILITIES:

9. Understand and adhere to established Agency policies and procedures 10. Time sheet calculation for both biweekly and semimonthly payroll runs 11. Data input regarding payroll into computerized payroll system and submittal prior to deadlines 12. Balancing payroll runs and report management 13. Gives employees access to online payroll system to access records 14. Answers employee questions regarding payroll records and pay stubs 15. Works with other office staff regarding payment of services as well as report generation 16. Manages benefit eligibility and enrollment for health insurance and 401K program 17. Tracks, coordinates, and manages health insurance and 401K deductions for the payroll system 18. Assists in taking time records and preparing for service billing 19. Assists in the management of personnel records to ensure compliance with necessary paperwork 20. Provides input regarding processes and systems as needed 21. Assists in project management and process improvement initiatives as requested. 22. Other duties as required

WORKING ENVIRONMENT: Works indoors in Agency.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Payroll/Human Resources Assistant…continued

JOB RELATIONSHIPS:

7. Supervised by: Controller

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Payroll/Human Resources Assistant…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Payroll/Human Resources Assistant, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Medical Billing Manager

JOB SUMMARY:

The Medical Billing Manager reports to the Business Office Manager of Professional Pediatric Home Care. This position is responsible for maintaining revenue by establishing, implementing, and controlling the billing system. The Medical Billing Manager will successfully manage, direct and monitor billing and reimbursement activities as well as develop new processes to increase reimbursements.

QUALIFICATIONS:  At least 5-7 years related experience  BA/BS degree, preferred  Healthcare billing experience required  Experienced analytical and problem solving skills  Complete understanding and experience using various billing software and systems.  Proficient in Microsoft Office and financial database software. LINE OF AUTHORITY: Reports to the Business Office Manager RESPONSIBILITIES:  Guides billing practices by researching, developing, writing, and updating billing policies, procedures, methods, and guidelines.  Inputting new claims, processing payments, and conducting billing research.  Reconciles and analyzes payments to contracts and what was billed. Monitors trends and tracks discrepancies while developing action plans to resolve issues. Monitors successful contractual compliance.  Liaison between patients, providers and management team. Acts as a resource to all departments regarding billing questions and concerns.  Meets billing operational standards by contributing billing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service standards; resolving problems; identifying billing system improvements.  Meets billing financial standards by providing annual billing budget information, identifying variances and implementing corrective actions.  Creates analysis and reports for management regularly and ad hoc.  Stay current with legal and regulatory changes in coding and billing and analyze and communicate reimbursement trends.  Other tasks as assigned

WORKING ENVIRONMENT: Works indoors

JOB RELATIONSHIPS:

1. Supervised by: Business Office Manager

RISK EXPOSURE: Low risk

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

None Up 1/3 1/3 None Up 1/3 2/3 to to ½ and to to and 1/3 more 1/3 1/2 more Stand √ Wet, humid conditions (non-weather) √ Walk √ Work near moving mechanical parts √ Sit √ Fumes or airborne particles √ Talk or hear √ Toxic or caustic chemicals √ Use hands to finger, handle √ Outdoor weather conditions √ or feel Push/pull √ Extreme cold (non-weather) √ Stoop, kneel, crouch or crawl √ Extreme heat (non-weather) √ Reach with hands and arms √ Risk of electrical shock √ Taste or smell √ Work with explosives √ Risk of radiation √ Vibration √ This job requires that weight be lifted or force be exerted. Show how much & how often by checking the appropriate boxes below None Up 1/3 2/3 The typical noise level for the environment for the work environment to to ½ and is: (Check all that apply) 1/3 more Up to 10 pounds √  Very Quiet  Loud Noise  Quiet Up to 25 pounds √  Moderate Noise  Very Loud Noise Up to 50 pounds √ Up to 100 pounds √ Hearing: More than 100 pounds √  Ability to hear alarms on equipment  Ability to hear patient call  Ability to hear instructions from staff

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only √  Distance Vision (clear vision at 20 feet or more) Left only √  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Medical Billing Manager…continued

I have read the above job description and fully understand the conditions set forth therein, and if employed as Medical Billing Manager, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

JOB DESCRIPTION Training and Documentation Manager

JOB SUMMARY:

Train new and existing therapists on the electronic medical record system as well as ensure that updated and accurate documentation is coming in and out of the medical record system.

QUALIFICATIONS:

9. Strong knowledge of Microsoft Office Programs (Word, Excel, Access) and general computer skills 10. Ability to use basic office equipment (computer, emailing, phone system including voice mail, fax machine, scanner, copy machine, and postage machine) 11. Proficient typing skills and spelling skills 12. Strong organizational skills and attention to detail 13. Ability to prioritize and multi-task 14. Exceptional customer-oriented demeanor and phone skills 15. Problem Solving Skills 16. Bachelor’s degree preferred.

LINE OF AUTHORITY: Reports to the Business Office Manager

RESPONSIBILITIES:

12. Understand and adhere to established Agency policies and procedures. 13. Knowledge of and adherence to ACHC standards and regulations related to medical record requirements. 14. Training of therapists to the electronic medical record system. Includes how to document a comprehensive assessment, functional assessment, treatment plan, and therapy note. Shows therapists how to communicate through the system, coordinate care, schedule, get reports, and update personnel record information. 15. Assigns passwords and medical record access as well as takes them away. 16. Create, review, and follow up on reports to ensure ACHC standards are being met. 17. Ensures Physician orders are sent out and received on a timely basis in accordance with ACHC standards. 18. Ensure therapists are submitting documentation timely and in accordance with ACHC standards. Set up follow up and action plans with therapists as needed. 19. Direct supervision over the Medical Administrative Assistant position. 20. Assist in answering and direct phone inquiries through phone system management in a courteous manner, as needed. Includes transfer of calls and transferring to voice mail 21. Manage distribution of incoming mail. 22. Manage the maintaining, tracking, and ordering of office supplies on a monthly basis 23. Project management which includes but not limited to in-service training support, annual education, and annual satisfaction survey mailing and tracking 24. Provide assistance with staffing, as needed. 25. Provide input to the Business Office Manager regarding therapist documentation performance in terms of timeliness and accuracy of reporting. Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Training and Documentation Manager…continued

WORKING ENVIRONMENT: Works indoors in Agency.

JOB RELATIONSHIPS:

8. Supervised by: Business Office Manager 9. Supervises: Medical Administrative Assistant

RISK EXPOSURE: Low risk

PHYSICAL REQUIREMENTS:

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Job Description – Training and Documentation Manager…continued

REPETITIVE MOTION ACTIONS - Number of Hours - This job has special vision requirements; check all that apply Repetitive use of Foot Control 0 1-2 3-4 5-6 7+  Close vision (clear vision at 20 inches or less) Right only  Distance Vision (clear vision at 20 feet or more) Left only  Color Vision (ability to identify and distinguish colors) Both √  Peripheral Vision Repetitive use of Hands  Depth Perception Right only  Ability to Adjust Focus Left only  No Special Vision Requirements Both √ Grasping: simple/light Special demands not listed: Right only Left only Both √ Grasping: firm/heavy Right only Left only Note: Reasonable accommodations may be made to enable individuals Both √ with disabilities to perform the essential functions of the position Fine Dexterity Right only Left only Both √

I have read the above job description and fully understand the conditions set forth therein, and if employed as Training and Documentation Manager, I will perform these duties to the best of my knowledge and ability.

______Date Signature

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH4-2I, HH4-2J

Performance Appraisals/Evaluations

______POLICY All employees will have a performance appraisal/evaluation based upon their job description annually. In addition, there will be an ongoing informal performance review process through supervisory interaction to ensure continued employee growth and development. ______PURPOSE To review job performance based upon an employee’s job description; to clarify duties and responsibilities; to determine the appropriateness of the description and the need for further training; to recognize good performance and the accomplishment of goals; to inform employees of their progress and discuss ways in which performance may be improved; to encourage personal development; to provide a basis upon which to make compensation decisions. ______REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies ______RELATED DOCUMENTS “Performance Appraisal/Evaluation” discipline-specific forms ______PROCEDURE 1. Performance evaluations will be conducted by the employee’s immediate supervisor no less frequently than every 12 months.  An annual performance evaluation will be conducted for any part-time employees that have worked for 6 months or longer in a year. 2. Performance may be reviewed at any time the supervisory staff feels a need to discuss the quality of work with an employee. 3. The supervisor may seek input from other supervisors or peers to be considered during the evaluation process. 4. Performance evaluation results must be shared with the employee by a face-to-face conference with the supervisor. A copy of the performance evaluation must be reviewed by the employee and signed by the individual performing the evaluation and the employee. 5. There will be an annual evaluation of all direct care personnel.

Professional Pediatric Home Care December 2012 7.20 ACHC Standard HH1-5A.01, HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Administrator

1 2 3 4 Ensure the Agency’s skilled health services are in compliance with all applicable regulations, Accrediting Organization standards (if applicable), and federal, state, and local laws. Ensures the completion, maintenance and submission of such reports and records as required by the Colorado Department of Public Health and Environment. Ensures the Agency’s ongoing liaison with the Governing Body, Professional Advisory Committee, staff members and the community. Maintains a current organizational chart to show lines of authority down to the patient level. Develops and implements objectives, manages all business affairs and the overall operation of the Agency. Ensures the maintenance of appropriate personnel, financial and administrative records and all policies and procedures of the agency. Employs qualified personnel in accordance with written job descriptions and ensures adequate staff education, supervision and evaluations. Ensures orientation of new staff, regularly scheduled in-service education programs and opportunities for continuing education for the staff. Designation, in writing, of a qualified staff member to act in the absence of the administrator. Ensures availability of the administrator or designee for all hours that employees are providing services, at minimum, any eight (8) hour period between 7 a.m. and 7 p.m. Monday through Friday. Ensures all marketing, advertising and promotional information and activities accurately represents the Agency and addresses the care, treatment and services that the Agency can provide directly or through contractual arrangement. Plans, organizes and directs the Agency’s ongoing functions by delegating duties and establishing a formal means of staff accountability. Implements Agency policies and procedures. Directs and coordinates the overall development and administration of the Agency consistent with the Agency mission and available resources, and with the involvement of the Agency staff and participation of the Professional Advisory Committee. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Professional Pediatric Home Care December 2012 7.21A ACHC Standard HH1-5A.01, HH4-2J

Performance Appraisal/Evaluation – Administrator…continued

1 2 3 4 Provides leadership in the development of strategic long-term plans. Provides direction in formulating the programs and policies. Evaluates effectiveness and efficiency of the Agency services and programs. Directs daily business activities of the Agency and assures development of systems that support recruitment, hiring and the ongoing professional development of Agency staff. Participates in the hiring and orientation of staff, and development of continuing education (staff development) in applicable policies, rules, regulations and resource materials. Establishes criteria and procedures for selection, promotion, discipline and termination of employment of personnel. Develops and implements employee compensation program. Ensures that confidentiality and privacy procedures are adopted and followed. Serves as a resource person to employees. Develops implements and evaluates budget plan and cost control methods. Establishes and maintains effective means of communication. Serves on the Professional Advisory Committee and Quality Management Committee. Appoints members and their terms of membership to the Quality Management Committee. Ensures 24 hour/day, seven (7) days/week on-call coverage. Implements an effective budgeting and accounting system; assures accuracy for billing procedures. Monitors equipment use and takes steps to keep abuse to a minimum. Uses statistical data to determine quality and quantity of services. Participates in personal professional growth and development. Ensure Agency personnel have current clinical information and current practices. Maintains current knowledge of local trends and issue. Completes initial and annual administrator training, as applicable, per the requirements of 6 CCR 1011-1 Chapter 26 section 7.6. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments:

Professional Pediatric Home Care December 2012 7.21A ACHC Standard HH1-5A.01, HH4-2J

Performance Appraisal/Evaluation – Administrator…continued

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 2012 7.21A ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Director of Nursing

1 2 3 4 Understands and adheres to all applicable regulations, standards, and federal, state, and local laws and established Agency policies and procedures. Participates in the development of standards which ensure safe and therapeutically effective service to patient/family. Ability to supervise, guide and develop patient care personnel skills and performances. Consults with the Administrator in determining a staffing pattern which will accomplish stated objectives and promote a maximum level of utilization of patient care personnel. Responsible for recruiting, hiring, evaluating and terminating personnel. Assists in instituting, interpreting and documenting disciplinary action. Responsible for the orientation of new patient care personnel. Assists in the planning and consultative needs of staff. Responsible for the preparation and implementation of policies and procedures which meet Medicare, Medicaid, Accrediting Organization (if applicable), and federal, state and local laws. Supports policies and procedures and uses appropriate channels for changes of such policies. Responsible for the coordination of interdisciplinary team services. Designation, in writing, of a qualified staff member to act in the absence of the Director. Ensures availability of the Director of Nursing or designee for all hours that employees are providing services, at minimum, any eight (8) hour period between 7 a.m. and 7 p.m. Monday through Friday. Responsible for the organization of patient care services to delineate and delegate functional responsibility, lines of relationship and communication to provide safe and therapeutically effective service. Responsible for the coordination of Agency’s services with the services of other community agencies. Participates in studies and research and other administrative functions as assigned. Observes confidentiality and safeguards all patient related information. Accepts responsibility for regular attendance and punctuality; fulfills job related requirements without regard to time involved. Serves as a resource person to employees. Develops a cooperative relationship and communicates effectively and professionally with physicians and referral sources. Investigates, resolves and reports any problem relating to patient care and/or employee well-being. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – Director of Nursing…continued 1 2 3 4 Immediately investigates and resolves any accident, incident, lost articles or unusual occurrence and reports to the Administrator as necessary. Attends pertinent continuing education programs other than routine in- services and shares information with staff. Monitors equipment for appropriate use and takes steps to keep misuse to a minimum. Responsible for the Agency’s ongoing Quality Management (QM) program as the QI Coordinator. Assists with the overall development and implementation of the QM plan, the identification of goals related to patient outcomes and coordinating, participating, and reporting of activities and outcomes results. Functions as Agency infection control manager. Responsible for the development, implementation and evaluation of patient plans of care. Responsible for the review of patient medical records for compliance with federal, state and local laws, Accrediting Organization standards (if applicable), and Agency policies and guidelines. Assists Nursing Supervisor in conducting patient care conferences, staff meetings and maintains documentation. Participates in community education projects. Ensures that all necessary supplies and equipment are available. Uses statistical data to determine quality and quantity of services. Participates in personal professional growth and development. Ensures Agency personnel have current clinical information and current practices. Maintains current knowledge of local trends and issue. Completes initial and annual administrator training, as applicable, per the requirements of 6 CCR 1011-1 Chapter 26 section 7.6. Must be able to perform nursing functions in times of staff shortage. Available to share on-call with nursing personnel as needed. Ensures that documentation is completed in accordance with Agency policy. Assists with staffing visit assignments and on-call. Other duties as assigned by the Administrator. Acts as Administrator in the Administrator’s absence. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – Director of Nursing…continued

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Controller

1 2 3 4 Convert the companies cash basis books to accrual basis (initially) Develop and maintain all appropriate internal controls in conjunction with the President. Manage accounting and payroll activities as well as accounting functional areas (invoice processing, billing, cash receipts, receivable collections, month-end close, journal entries, statistical data, and payroll). Ensure that all internal and external reporting deadlines are met. Manage workflow, timeliness and analytical review of all budget and forecast data. Manage and provide necessary support to financial audits including internal audits, external audits and peer reviews. Perform other job-related duties as assigned or apparent.

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Business Development Manager

1 2 3 4 Research, develop and implement a Brand and Communication strategy, standards and practices company-wide that elicit the behavior, emotion and recognition objectives of the company. Development of key messages for all audiences to communicate our core brand identity. Lead agencies and internal team members where appropriate to execute all communication activities and public relations (marketing materials, advertising, client communications, direct mail, marketing campaigns, press releases, content for trade publications, etc.). Oversee the writing of press releases, copy for marketing materials, annual reports, advertisements, and other related material. Manage media relations, research marketing opportunities and build relationships with key industries. Work closely with the Web Manager to ensure messaging is consistent with overall marketing and communication objectives. Build and maintain strong relationships with internal and external key stakeholders to ensure proper messaging of company beliefs and service offerings. Provide reporting to the President as well as at Board of Director meetings. Will include but not be limited to reporting on the status of prioritized marketing and communication activities. Reporting will be both historical and forward looking. Develop and manage the communications budget. Contributes to the total effectiveness of the department, communicating openly, solving problems proactively, offering creative ideas and working as a positive, engaged team member. Budget management. To deliver all marketing activity within the agreed budget. To manage all aspects of print production, receipt and distribution. Assists in management of recruiting functions. Performs related work as required 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals: December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Director of Therapy

1 2 3 4 Accomplishes therapy human resource strategies by determining accountabilities; communicating and enforcing values, policies, and procedures; implementing recruitment, selection, orientation, training, coaching, counseling, disciplinary, and communication programs; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation strategies. Develops therapy organizational strategies by contributing information, analysis, and recommendations to strategic thinking and direction; establishing functional objectives in line with organizational objectives. Establishes therapy operational strategies by evaluating trends; establishing critical measurements; determining production, productivity, quality, and patient-service strategies; designing systems; accumulating resources; resolving problems; implementing change. Develops therapy financial strategies by estimating, forecasting, and anticipating requirements, trends, and variances; aligning monetary resources; developing action plans; measuring and analyzing results; initiating corrective actions; minimizing the impact of variances. Provides therapy services by evaluating patient care protocols; measuring outcomes; researching and evaluating emerging trends. Assures therapy quality services by establishing and maintaining departmental quality assurance program including monitoring of quality indicators (treatment plans, daily notes, home programs), documenting actions taken to resolve problems, and reporting to the medical care evaluation committee in accordance with ACHC standards. Provides therapist education programs as well as computer system training, as determined through the quality assurance program. Provides academic and clinical experiences by maintaining liaison with area colleges; directing the clinical education program for therapy interns; and speaking at local colleges as requested. Assists in establishing and maintaining referral relationships including physicians, hospitals, clinics, case management agencies and other referral sources. Maintains legal and accreditation compliance by developing policy positions concerning federal, state, and local regulations, and ACHC standards; anticipating emerging issues. Assists the business office with scheduling therapists to appropriate cases, as requested.

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

December 2012 7.21 ACHC Standard HH4-2J

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Business Office Manager

1 2 3 4 Manages and coordinates all aspects of patient intake, scheduling, insurance verification, reception, and patient medical records including ongoing physician orders. Ensures staff obtain appropriate referrals and prior authorizations by third-party payers for services provided and billed; ensures that denials of claims are properly tracked, monitored, and resolved. Oversees and coordinates the preparation and disposition of timely and accurate review and filing of medical treatment documentation. Ensures compliance with standard and HIPPA policies relating to patient registration, billing, medical records, documentation, and transcription issues. Establishes and implements short- and long-range organizational goals, objectives, policies, and operating procedures; monitors and evaluates operational effectiveness; effects changes required for improvement. Oversees the supervision of personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance. Recruiting, interviewing and hiring new internal office staff. Develops procedures and trains staff on new policies. Develops and monitors office budgets, monitors resource utilization and initiates purchase requests. Performs miscellaneous job-related duties as assigned. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Nursing Supervisor

1 2 3 4 Understands and adheres to all applicable regulations, standards, and federal, state, and local laws and established Agency policies and procedures. Participates in the development of standards which ensure safe and therapeutically effective service to patient/family. Ability to supervise, guide and develop patient care personnel skills and performances. Consults with the Director of Nursing/Administrator in determining a staffing pattern which will accomplish stated objectives and promote a maximum level of utilization of patient care personnel. Assists in recruiting, hiring, evaluating and terminating personnel. Assists in instituting, interpreting and documenting disciplinary action. Responsible for the orientation of new patient care personnel. Assists in the planning and consultative needs of staff. Assists in the preparation and implementation of policies and procedures which meet Medicare, Medicaid, Accrediting Organization (if applicable), and federal, state and local laws. Displays a willingness to support policies and procedures and uses appropriate channels for changes of such policies. Assists in the coordination of interdisciplinary team services. Assists in the organization of patient care services to delineate and delegate functional responsibility, lines of relationship and communication to provide safe and therapeutically effective service. Participates in the coordination of Agency’s services with the services of other community agencies. Participates in studies and research and other administrative functions as assigned. Observes confidentiality and safeguards all patient related information. Accepts responsibility for regular attendance and punctuality; fulfills job related requirements without regard to time involved. Serves as a resource person to employees. Develops a cooperative relationship and communicates effectively and professionally with physicians and referral sources. Immediately reports any complaint, accident, incident, lost articles or unusual occurrence to the Agency Manager. Ensures completion of in-service training with staff. Ensures that all necessary supplies and equipment are available and monitors for appropriate use and takes steps to keep misuse to a minimum. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation - Supervisor…continued

1 2 3 4 Assists with the Agency’s ongoing Quality Management (QM) program. Assists with the development, implementation and evaluation of patient plans of care. Reviews patient medical records for compliance with federal, state, local and Agency policies and guidelines. Assists Director of Nursing/Administrator in conducting patient care conferences, staff meetings and maintains documentation. Participates in community education projects. Ensures that all necessary supplies and equipment are available. Must be able to perform nursing functions in times of staff shortage Available to share on-call with nursing personnel as needed. Ensures that documentation is completed in accordance with Agency policy. Assists with staffing visit assignments and on-call. Participates in on-call rotation as needed. Other duties as assigned by the Agency Manager. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Registered Nurse (RN)

1 2 3 4 Provides services in accordance with the plan of care. Makes the initial evaluation visit and regularly reevaluates the patient’s nursing needs. Initiates the plan of care and necessary revisions. Furnishes those services requiring substantial specialized nursing skill. Initiates appropriate preventive and rehabilitative nursing procedures. Prepares clinical and progress notes for each patient visit and summaries of care conferences on patients in a timely manner as per Agency policy. Coordinates services. Informs physician and other personnel of changes in the patient’s condition and needs. Counsels the patient and family/significant others in meeting nursing and related needs. Participates in in-service programs, supervising and teaching other nursing personnel. Understands and adheres to established Agency policies and procedures. Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries. Determines the amount and type of nursing needed by each individual patient. Refers to Physical Therapist, Speech Language Pathologist, Occupational Therapist and Medical Social Worker those patients requiring their specialized skills. Supervises the LPN/LVN every 30-days and teaches other nursing personnel. Conducts patient care conferences on patients assigned to his/her care. Participates in peer review and quality management as assigned. Participates in utilization review of medical records as assigned. Gives total patient care as needed. Takes on-call duty nights, weekends and holidays, as assigned. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. Appropriately utilizes ICD-9 diagnoses and codes. Observes confidentiality, safeguards all patient related information. Attends staff meetings and patient care conferences as scheduled. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Professional Pediatric Home Care December 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – Registered Nurse…continued 1 2 3 4 Completes documentation and paperwork in a timely manner per Agency policy. Immediately reports to Director of Nursing/Nursing Supervisor any patient incidents/variances or complaints. Demonstrates competent performance of technical skills according to established procedures. Understands and adheres to established policies/procedures. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor. Appearance is always within Agency standard; is clean and well groomed. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. Maintains clean and neat work environment. Demonstrates sound judgment, critical thinking and decision making. Maintains current CPR certification. Performs other duties as assigned. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

Professional Pediatric Home Care December 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Licensed Practical (Vocational) Nurse (LPN/LVN))

1 2 3 4 Furnishes services, treatments and diagnostic and preventive procedures as assigned per the plan of care, in accordance with agency policies. Prepares clinical and progress notes. Assists the physician, the intermediate care provider and RN in performing specialized procedures. Prepares equipment and materials for treatments observing aseptic technique as required. Assists the patient in learning appropriate self-care techniques. Understands and adheres to established policies and procedures. Implements the nursing care plan for each patient. Initiates preventive and rehabilitative nursing procedures as appropriate. Observes signs and symptoms and reports to the physician and registered nurse reactions to treatments, including drugs and changes in the patient's physical or emotional condition. Teaches and counsels the patient and family/significant others regarding the nursing care needs and other related problems of the patient at home. Evaluates with registered nurse the effectiveness of the LPN/LVN's nursing service to the patient and family under the guidance of the registered nurse. Maintains accurate and complete records of observations, treatments and care of patient. Participates in medical record audit as assigned. Attends staff meetings, patient care conferences and in-services as scheduled. Takes on-call duty, nights, weekends and holidays as assigned. Submits any changes in schedule to Director of Nursing/Nursing Supervisor/ Registered Nurse on a daily basis. Participates in patient care conferences to discuss the need for involvement of other members of the health team, such as physical therapist or speech language pathologist. Observes aseptic technique as required. Accepts, writes and executes orders; orders are cosigned by RN. Assures that the patient/family is involved in implementing the plan of care. Assists in reviewing, evaluating and updating the patient plan of care as appropriate. Administers medications and treatments as ordered. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – LPN/LVN…continued 1 2 3 4 Provides appropriate information regarding patient to other agencies/ individuals involved in patient's care as needed. Observes confidentiality and safeguards all patient related information. Attends staff meetings and patient care conferences as scheduled. Completes documentation and paperwork in a timely manner as per Agency policy. Immediately reports to Director of Nursing/Nursing Supervisor/RN any patient incidents/variances or complaints. Demonstrates competent performance of technical skills according to established procedures before performing new skills. Participates in peer review and QM activities as assigned. Participates in utilization review of medical records as assigned. Understands and adheres to established policies/procedures. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to Nursing Supervisor/RN. Appearance is always within Agency standards; is clean and well groomed. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. Participates in in-service programs as assigned. Maintains clean and neat work environment. Demonstrates sound judgment, critical thinking and decision making. Maintains current CPR certification. Performs other duties as assigned. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards Comments

Evaluation of past goals:

Establishment of new goals:

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date PERFORMANCE APPRAISAL/EVALUATION Medical Social Worker (MSW)

1 2 3 4 Assists physician, or intermediate care provider, and other team members in understanding the significant social and emotional factors related to the health problems. Participates in the development of the plan of care. Prepares clinical and progress notes. Works with the family. Participates in the coordination of Agency's services with the services of other community resources; uses community resources. Participates in discharge planning. Participates in in-services and/or continuing education programs. Acts as a consultant to other Agency personnel. Understands and adheres to established Agency policies/procedures. Observes confidentiality and safeguards all patient information. Serves as a resource person to employees, patients, physicians and other allied healthcare providers. Develops a cooperative relationship and communicates effectively and professionally with physicians. Immediately reports any accident, incident, lost articles or unusual occurrence to Director of Nursing/Nursing Supervisor. Participates in staff meetings and patient care conferences as scheduled. Maintains contact with community support groups and provides professional expertise as required. Plans/coordinates social services within the Agency. Promotes community awareness of services provided. Participates in the development of the plan of care; ensures that the patient plan of care includes identified problems, interventions and goals. Participates in community activities and facilitates community awareness and support. Provides psychosocial services in accordance with established standards. Evaluates quality of psychosocial services provided. Informs the RN of changes in the patient's condition and needs. Schedules patient visits as necessary according to patient needs and as physician orders. Observes confidentiality and safeguards all patient related information. Attends staff meetings and patient care conferences as scheduled. Completes documentation and paperwork in a timely manner as per Agency policy; prepares clinical and progress notes. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – MSW…continued

1 2 3 4 Participates in peer review and QM activities as requested. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor. Appearance is always within Agency standards; is clean and well groomed. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. Maintains clean and neat work environment. Demonstrates sound judgment and decision making. Maintains current CPR certification. Performs other duties as assigned. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Physical Therapist (PT)

1 2 3 4 Assists the physician or intermediate care provider in evaluating level of function, helps develop the plan of care and revise as necessary. Prepares clinical and progress notes. Advises and consults with the family and other agency personnel. Participates in in-service programs and presents in-service programs as assigned. Understands and adheres to established policies and procedures. Participates with all other health care personnel in patient care planning. Directs and supervises assistant (PTA) personnel as required. Completes initial history and evaluation visit, notifies physician of patient needs and submits plan of care and orders for physician approval. Performs all skilled physical therapy procedures as ordered by physician. Consults with physicians regarding change in treatment. Writes reports to physicians regarding patient's progress. Instructs patients and family/significant others in home programs and activities of daily living. Attends all staff meetings and patient care conferences as scheduled. Supervises the PTA every 30-days as assigned. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. Appropriately utilizes ICD-9 diagnoses and codes. Directs and supervises performance of PTA as indicated. Completes a discharge summary upon completion of therapy services. Completes a recertification for physician every 60 days if further treatment is to be continued. Instruction to patient/family in home program with documentation in medical record notes. Observes confidentiality and safeguards all patient related information. Prepares and submits patient evaluations, clinical and progress notes in a timely manner as outlined in Agency policy. Immediately reports to Director of Nursing/Nursing Supervisor/RN any patient incidents/variances or complaints. Participates in peer review and QM activities as requested. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 – Exceeds Standards

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – PT…continued

1 2 3 4 Participates in utilization review of medical records as assigned. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor/Therapy Supervisor. Appearance is always within Agency standards; is clean and well groomed. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. Maintains clean and neat work environment. Demonstrates sound judgment, critical thinking and decision making. Maintains current CPR certification. Performs other duties as assigned. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Physical Therapy Assistant (PTA)

1 2 3 4 Performs services planned, delegated and supervised by the Physical Therapist. Assists in preparing clinical and progress notes. Participates in educating the patient and family. Participates in in-service programs and presents in-service programs as assigned. Understands and adheres to established Agency policies and procedures. Provides physician prescribed physical therapy under a written plan of care established by the PT. Participates with all other health care personnel in patient care planning. Consults with PT regarding change in treatment. Instructs patients and family members in home programs and activities of daily living. Attends all staff meetings and patient care conferences as scheduled. Prepares medical records, progress notes and updates care plans for each patient visit in a timely manner as per Agency policy. Informs the PT and other team members of changes in the patient's condition and needs. Continually reevaluates needs of patient/family. Coordinates the therapy aspects of patient care with the PT. Consults with PT to determine whether treatment plan should be continued, changed or terminated. Instruction to patient/family in home program with documentation in medical record notes. Observes confidentiality and safeguards all patient related information. Completes and submits progress notes and paperwork in a timely manner per Agency policy. Immediately reports to supervising Physical Therapist any patient incidents/variances or complaints. Demonstrates competent performances of technical skills according to established procedures. Participates in peer review and QM activities as requested. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to supervising Physical Therapist. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 – Exceeds Standards

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – PTA…continued

1 2 3 4 Appearance is always within Agency standards; is clean and well groomed. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. Maintains clean and neat work environment. Demonstrates sound judgment and decision making. Maintains current CPR certification. Performs other duties as assigned. 1 – Does Not Meet Standards 2 – Needs Improvement 3 – Meets Standards 4 – Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Occupational Therapist (OT)

1 2 3 4 Assists the physician or intermediate care provider in evaluating level of function, helps develop the plan of care and revise as necessary. Prepares clinical and progress notes. Advises and consults with the family and other agency personnel. Participates in in-service programs and presents in-service programs as assigned. Understands and adheres to established policies and procedures. Participates with all other health care personnel in patient care planning. Directs and supervises assistant (COTA) personnel as required. Completes initial history and evaluation visit, notifies physician of patient needs and submits plan of care and orders for physician approval. Performs all skilled occupational therapy procedures as ordered by physician. Consults with physicians regarding change in treatment. Writes reports to physicians regarding patient's progress. Instructs patients and family/significant others in home programs and activities of daily living. Attends all staff meetings and patient care conferences as scheduled. Supervises the COTA every 30-days as assigned. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. Appropriately utilizes ICD-9 diagnoses and codes. Directs and supervises performance of COTA every 30 days as assigned. Completes a discharge summary upon completion of therapy services. Completes a recertification for physician every 60 days if further treatment is to be continued. Instruction to patient/family in home program with documentation in medical record notes. Observes confidentiality and safeguards all patient related information. Prepares and submits patient evaluations, clinical and progress notes in a timely manner as outlined in Agency policy. Immediately reports to Director of Nursing/Nursing Supervisor/RN any patient incidents/variances or complaints. Participates in peer review and QM activities as requested. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 – Exceeds Standards

Professional Pediatric Home Care December 2012 December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – OT…continued

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

Professional Pediatric Home Care December 2012 December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Certified Occupational Therapy Assistant (COTA)

1 2 3 4 Performs services planned, delegated and supervised by the Occupational Therapist. Assists in preparing clinical and progress notes. Participates in educating the patient and family. Participates in in-service programs and presents in-service programs as assigned. Understands and adheres to established Agency policies and procedures. Provides physician prescribed occupational therapy under a written plan of care established by the OT. Participates with all other health care personnel in patient care planning. Consults with OT regarding change in treatment. Instructs patients and family members in home programs and activities of daily living. Attends all staff meetings and patient care conferences as scheduled. Prepares medical records, progress notes and updates care plans for each patient visit in a timely manner as per Agency policy. Informs the OT and other team members of changes in the patient's condition and needs. Continually reevaluates needs of patient/family. Coordinates the therapy aspects of patient care with the OT. Consults with OT to determine whether treatment plan should be continued, changed or terminated. Instruction to patient/family in home program with documentation in medical record notes. Observes confidentiality and safeguards all patient related information. Completes and submits progress notes and paperwork in a timely manner per Agency policy. Immediately reports to supervising Occupational Therapist any patient incidents/variances or complaints. Demonstrates competent performances of technical skills according to established procedures. Participates in peer review and QM activities as requested. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to supervising Occupational Therapist. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 – Exceeds Standards

December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – COTA…continued

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Speech Language Pathologist (SLP)

1 2 3 4 Assists the physician or intermediate care provider in evaluating level of function, helps develop the plan of care and revise as necessary. Prepares clinical and progress notes. Advises and consults with the family and other agency personnel. Participates in in-service programs and presents in-service programs as assigned. Understands and adheres to established policies and procedures. Participates with all other health care personnel in patient care planning. Completes initial history and evaluation visit, notifies physician of patient needs and submits plan of care and orders for physician approval. Performs all skilled Speech Language Pathology services as ordered by physician. Consults with physicians regarding change in treatment. Writes reports to physicians regarding patient's progress. Instructs patients and family/significant others in home programs. Attends all staff meetings and patient care conferences as scheduled. Completes and submits OASIS assessments, reassessments, and transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames. Appropriately utilizes ICD-9 diagnoses and codes. Completes a discharge summary upon completion of therapy services. Completes a recertification for physician every 60 days if further treatment is to be continued. Instruction to patient/family in home program with documentation in medical record notes. Observes confidentiality and safeguards all patient related information. Prepares and submits patient evaluations, clinical and progress notes in a timely manner as outlined in Agency policy. Immediately reports to Director of Nursing/ Supervisor any patient incidents/ variances or complaints. Participates in peer review and QM activities as requested. Participates in utilization review of medical records as assigned. Adheres to Agency standards and consistently interprets and accurately performs all assigned responsibilities. Maintains acceptable attendance status, per Agency policy. Reports all incomplete work assignments to Director of Nursing/Nursing Supervisor/Therapy Supervisor. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

December 2012 7.21 ACHC Standard HH4-2J

Performance Appraisal/Evaluation – SLP…continued

1 2 3 4 Appearance is always within Agency standards; is clean and well groomed. Demonstrates effective time management skills through daily documentation and infrequent overtime for routine assignments. Maintains clean and neat work environment. Demonstrates sound judgment, critical thinking and decision making. Maintains current CPR certification. Performs other duties as assigned. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Intake Coordinator

1 2 3 4 This position integrates the PPHC Mission, Vision, and Values into each of the responsibilities of this job and daily communication with customers and co-workers. This position adheres to and is responsible for following the established quality performance standards in accordance with regulatory requirements. This position actively maintains confidentiality for our patients and their families as outlined in the PPHC Patient Confidentiality Policy and shows the same level of respect for every Associate with in PPHC. Provides telephone intake of information relating to patient referrals. Gets H&P from physician regarding care needs. Determines appropriateness of referral to home care based on established criteria. Disseminates the intake information to appropriate sources. Obtains/receives initial physician and change orders. Enters referral and other appropriate information into the computer Provides follow up regarding the start of services and patient satisfaction. Obtains, reviews, and enters the provider specific care plans and goals into the initial physician order upon receipt. Obtains initial authorization for services on Medicaid patients. Participates in the medication review process for all clinical records. Assists Supervisory team with other duties as needed. Attend in-services and continuing education programs when appropriate and assigned. Remain current on innovations, developments, new procedures, and techniques in nursing care as it may pertain to clinical referral information. Actively participates in system development and supports staff participation throughout the department. Performs other duties as assigned.

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

December 2012 7.21 ACHC Standard HH4-2J

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Therapy Coordinator

1 2 3 4 Receives patient therapy referrals Assigns therapists to cases based on specialty and area. Verifies eligibility for Medicaid services. Gives private insurance referrals to billing for private insurance intake. Informs billing manager of any add on services for private insurance authorization Receives verbal and/or written orders from primary care physician. Sends consent packages to families and follows up to ensure consent is received. Follows up with therapists to ensure services are being met. Sets up coordination of care plan and documentation for outside disciplines. Reassigns therapists and adds therapy services as needed. Communicates with therapists in a prompt, courteous, and helpful manner. Works with other PPHC internal staff regarding therapist needs Updates demographic, insurance and other necessary information in the computer records as needed. Assists with the answering of the telephone, screens calls, take messages, and provides information along with greeting patients in a prompt, courteous and helpful manner. Computer data entry of patient health information and/or typing of correspondence and documents. Uses computer system to add and distribute information to the patient electronic record or other appropriate sources. Creates and faxes requested information. Copies, sorts, and assembles documents as needed. Ensure all communications reflect the standards and mission of PPHC. Maintains patient confidentiality and follows HIPAA Guidelines. Display a consistently positive, cooperative, self-motivated, courteous and professional attitude. Performs other duties as assigned

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

December 2012 7.21 ACHC Standard HH4-2J

Evaluation of past goals:

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Medical Record Support Specialist

1 2 3 4 Maintain Access Database through Data Entry. Includes but not limited to maintenance and tracking of therapists’ “Plan of Care’s”, communication updates, address changes, and other patient record changes. Review of Therapist’s Plan of Care Records for compliance purposes (checklist of items to review are provided) Updating of therapy orders on 485 document, as needed Review of patient therapy records for quality control measures at 60 day recertification renewal. (Checklist) Track Physician Order renewal dates and print out of physician orders through the database system for clinical director review Track Medicaid Prior Authorizations Requests (PAR) through database system and prepare new authorizations when needed. Ability to request needed information from therapist’s and interact with therapists in a courteous manner Use of Email to communicate information to office personnel as necessary Answer and direct phone inquiries through phone system management in a courteous manner, as needed. Includes transfer of calls and transferring to voice mail Assist in processing of incoming mail and checking in of therapy billing, as needed Faxing of Medical Records to Physician Offices, as needed Filing of Medical Records in patient charts, as needed Mail out physician orders (including addressing, return envelope and applying postage) provided by Director of Nursing, as needed

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

December 2012 7.21 ACHC Standard HH4-2J

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Medical Administrative Assistant

1 2 3 4 Understand and adhere to established Agency policies and procedures. Answer and direct phone inquiries through phone system management in a courteous manner. Includes transfer of calls and transferring to voice mail. Process incoming mail including checking in billing statements and matching to therapy notes. Assist in transition of paper medical records to electronic system Use of Email to communicate information to office personnel as necessary Faxing and uploading of Medical Records to Physician Offices Filing and scanning of Medical Records as assigned, either paper or electronically Mail out physician orders provided by clinical personnel Follow up on receipt of physician orders provided by clinical personnel Maintain and track new patient consent packages. Track receipt of patient consent papers and follow up as needed Maintain, Track, and Order Office Supplies on a monthly basis Check patient Medicaid eligibility for each Medicaid patient on the first of each month Project management which includes but not limited to in-service training support and annual satisfaction survey mailing and tracking

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Billing Authorization Manager

1 2 3 4 Receive private insurance information from office staff on new patients. Verifies private insurance eligibility upon start and at least annually thereafter. Initiates authorization of services and visit span. Requests new authorizations as needed. Provides clinical information upon request. Receives and bills monthly private insurance billing dates, which also includes secondary billing as needed. Sends out invoices for private pays, co-pays, and deductibles. Private insurance claim follow up and resubmission as needed. Assists clients with grants and other funding access. Other duties as assigned

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Payroll/Human Resources Assistant

1 2 3 4 Understand and adhere to established Agency policies and procedures Time sheet calculation for both biweekly and semimonthly payroll runs Data input regarding payroll into computerized payroll system and submittal prior to deadlines Balancing payroll runs and report management Gives employees access to online payroll system to access records Answers employee questions regarding payroll records and pay stubs Works with other office staff regarding payment of services as well as report generation Manages benefit eligibility and enrollment for health insurance and 401K program Tracks, coordinates, and manages health insurance and 401K deductions for the payroll system Assists in taking time records and preparing for service billing Assists in the management of personnel records to ensure compliance with necessary paperwork Provides input regarding processes and systems as needed Assists in project management and process improvement initiatives as requested. Other duties as required

1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Medical Billing Manager

1 2 3 4 Guides billing practices by researching, developing, writing, and updating policies, procedures, methods, and guidelines. Inputting new claims, processing payments, and conducting billing research. Reconciles and analyzes payments to contracts and to what was billed. Monitors trends and tracks discrepancies while developing action plans to resolve issues. Monitors successful contractual compliance. Liaison between patients, providers and management team. Acts as a resource to all departments regarding billing questions and concerns. Meets billing operational standards by contributing billing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service standards; resolving problems; identifying billing system improvements. Meets billing financial standards by providing annual billing budget information, identifying variances and implementing corrective actions. Creates analysis and reports for management regularly and ad hoc. Stay current with legal and regulatory changes in coding and billing and analyze and communicate reimbursement trends. Other tasks as assigned 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

Establishment of new goals:

December 2012 7.21 ACHC Standard HH4-2J

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH4-2J

PERFORMANCE APPRAISAL/EVALUATION Training and Documentation Manager

1 2 3 4 Understand and adhere to established Agency policies and procedures. Knowledge of and adherence to ACHC standards and regulations related to medical record requirements. Training of therapists to the electronic medical record system. Includes how to document a comprehensive assessment, functional assessment, treatment plan, and therapy note. Shows therapists how to communicate through the system, coordinate care, schedule, get reports, and update personnel record information. Assigns passwords and medical record access as well as takes them away. Create, review, and follow up on reports to ensure ACHC standards are being met. Ensures Physician orders are sent out and received on a timely basis in accordance with ACHC standards. Ensure therapists are submitting documentation timely and in accordance with ACHC standards. Set up follow up and action plans with therapists as needed. Direct supervision over the Medical Administrative Assistant position. Assist in answering and direct phone inquiries through phone system management in a courteous manner, as needed. Includes transfer of calls and transferring to voice mail Manage distribution of incoming mail. Manage the maintaining, tracking, and ordering of office supplies on a monthly basis Project management which includes but not limited to in-service training support, annual education, and annual satisfaction survey mailing and tracking Provide assistance with staffing, as needed. Provide input to the Business Office Manager regarding therapist documentation performance in terms of timeliness and accuracy of reporting. 1 - Does Not Meet Standards 2 - Needs Improvement 3 - Meets Standards 4 - Exceeds Standards

Comments

Evaluation of past goals:

December 2012 7.21 ACHC Standard HH4-2J

Establishment of new goals:

Employee Signature Date Supervisor Signature Date

December 2012 7.21 ACHC Standard HH7-2A.01, HH7-2B.01

Roles and Responsibilities Related to Safety

______POLICY The Agency will train staff about their roles and responsibilities related to safety issues relating to service/care provision and education of staff members concerning safety.

______PURPOSE To minimize risks to patients and employees.

______PROCEDURE 1. During orientation and on an ongoing basis staff will be trained regarding risks about:  Hazardous materials and wastes.  Infectious materials and wastes.  Emergency management planning.  Body mechanics.  Workplace fire safety management and evacuation plan.  Patient and staff security issues.  Appropriate actions to eliminate and/or minimize safety risks. (i.e. icy parking areas and walkways, blocked exits, cluttered stairways etc).  Incident/risk, failures and/or user error reporting, occurrence reporting, including appropriate procedures to follow.  Workplace or office security.  Office equipment safety.  Personal safety techniques relating to in home service/care safety.

2. For patient safety in the home, the safety training activities may also include:  Compliance monitoring measures relating to the patient’s medication.  Safety measures relating to oxygen use (if applicable).  Patient medical equipment safety (if applicable).  Basic home safety measures (i.e. household chemicals, loose rugs, furniture layout, cluttered stairways, blocked exits, bathroom safety, electrical safety etc).  Use of restraints (if applicable).

3. All staff are required to implement Agency policies, procedures and processes for risk reduction and patient safety.

Professional Pediatric Home Care December 2012 7.22 ACHC Standard HH4-2F.01, HH4-2G.01

Driver License/Auto Insurance

______POLICY All personnel, who are required to operate a motor vehicle in the course of their duties, are required to have a valid driver license appropriate to the type of vehicle being operated in compliance with state laws and Agency policies, along with appropriate amount of automobile insurance.

______PURPOSE To define the requirements for valid drivers’ license and automobile insurance.

______PROCEDURE:

1. Evidence of a valid drivers’ license must be kept in personnel files.

2. Record of all inquires made on individual driving records (MVR) through the State Department of Motor Vehicles must be kept in personnel files.

3. A MVR check must be conducted on each staff member who is required to operate a motor vehicle in the course of his/her duties at the time of hire.

4. Staff who use a motor vehicle in the performance of their duties must keep the car in good working order.

5. Proof of auto insurance in the amounts of $100,000 bodily injury per person / $300,000 bodily injury per accident / $50,000 property damage must be current and maintained in the employee file.

Professional Pediatric Home Care December 2012 7.23