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So You Want to Open a Home Care Agency in New Hampshire?

September 8, 2014

Despite what many online “resources” may tell you, opening and maintaining a home care agency isn’t easy.  But what our members will tell you is, it is rewarding.  Following are some helpful links that you may need as you begin the process. These are just suggestions.  Always consult your business development lawyer to be sure you are adhering to current standards, policies and procedures.

There are many aspects to consider:

  • How driven will you be to grow your company?
  • Do you have what it takes to run your own business?
  • Does your service area carry a market large enough to support your projected growth?
  • Are you a people person that can sell your services to medical professionals and community leaders?
  • Have you got the expertise to hire and train people that are licensed or qualified to offer skilled and non-skilled home care services, and will you need someone to help you market those services?
  • How much can you afford to invest and what amount do you need to break even?

Begin by researching the market and the industry.

Once you are up and running, give us a call, we’d love to let you know more about our membership Association. 

Step 1: Create a business plan.

This is the first step in starting any type of business. You need to make a business plan for your home health care agency because it is the base of your company and will be needed for each step to follow. A business plan includes the following:

  • Executive summary – Explain the basics of your company.
  • Company description – Write the mission and goals of your home health care agency.
  • Services – Describe what services you will be providing.
  • Marketing plan – How will people learn about your business? Decide the pricing of your business as well.
  • Management and organization – Describe the ownership structure of you healthcare business.
  • Operational plan – Explain the facility and staff, as well as supplies you will need to operate.
  • Financial plan – This is where you will write a cash flow projection, balance sheet snapshot and break-even analysis.

OSG Capital: Home Health Care Business Plan

Step 2: Register with the state.

In order to receive payment from Medicare and Medicaid, your agency needs to meet the requirements put in place. Decide if you will need a 822 or 809 agency, and then certify your agency by completing the state’s home care application for a license.

Skilled Care is provided by Medicare certified home health agencies and reimbursed by Medicare, Medicaid, and private health insurance. Services include nursing care, therapy (physical, occupational, speech, and respiratory), as well as social services and hospice care. Following a specific plan of care, and under the supervision of a skilled discipline such as a nurse or therapist, a home health aide may provide personal care for a limited time. Skilled services are provided on an intermittent basis, with scheduled home visits to homebound clients only, under a plan of treatment ordered by a physician.

Non-Medical Care is provided by NH licensed home care agencies and payment methods include private pay, long term care insurance, and Medicaid. Caregiver duties involve personal care (bathing, grooming, and dressing), in addition to meal preparation, housekeeping, and running errands. Services may also include medication reminders, help with prescribed therapy exercises, and transportation to medical appointments. Non-medical home care can be arranged for any amount of time needed, ranging from an hour of respite to 24-hour care. Application for 822

You will also need to incorporate your business, get your tax identification and register for your NPI (National Provider Identification) number. These requirements for starting a home health care agency depend on a state-to-state basis.

New Hampshire Department of Health and Human Services: Health Facilities Administration

Step 3: Obtain Medicare and Medicaid certifications.

By obtaining these certifications, your agency will be able to provide health care services such as nursing care, physical therapy, and other services and get paid by Medicare and Medicaid plans. Be aware that this process of becoming accredited can take longer than you think, sometimes even up to a year. To apply and go through the survey process, visit cms.gov.

Step 4: Hire a great staff.

Since your home health care business is providing personal service to patients, you want a staff that represents and reflects what you want your business to be. Once you interview potential staff members, make sure you conduct thorough background checks to avoid legal action if there is any problem with care from an employee.

Step 5: Get your clients.

Once you have a business plan in place and your ideal staff lined up, it’s time to get clients and start operating your business. This step is one of the most difficult parts of owning any type of business, especially a service-based business like a home health care agency.

Effective marketing strategies are crucial for obtaining clients. Here are some basic marketing ideas you can implement to get your business going:

  1. You need to have an online presence. Build yourself a basic website to get your information and name out there. There are many free hosts that help you create a functioning website. You can always come back to your website and improve it and edit it as needed, but in order to get clients for your home healthcare business, you’ll need a website to represent your company.
  2. Let Google know you exist. Register your healthcare agency with Google so your address, hours and phone number can be accessible for potential clients. This is easy, but make sure you have your website first.
  3. Know your differentiating factors. If you have a prospective client, let them know what makes you different and better than the competition. Outline this for your employees and on your website to send a clear brand message.
  4. Join local groups and organizations. Show your professionalism and get your name out there by joining the Alliance and National Association for Home Care & Hospice.

Step 6: Have a solid plan for growth.

The key to growing your home care agency is not as complex as it may seem. However, it is easy to get off track and waste a lot of money and time. By following these simple tips and focusing on having high quality marketing materials, marketing to the right audience, and recruiting and hiring the right staff, you can quickly add capacity to your company, and increase your bottom line. Home Care Pulse: 5 Ways to Grow Your Home Care Business

 

Leslie Hammond
Director of Education & Communication
Home Care, Hospice & Palliative Care Alliance

8 Green St., Concord NH 03301
(603) 225-5597

 

New Hampshire Licensure Links

New Hampshire Department of Health and Human Services, Bureau of Health Facilities Administration

New Hampshire’s Title XI Hospitals & Sanitaria Chapter 151

Administrative Rules 822: Home Care Service Provider Agency

  • means any organization or business entity, except as identified in He-P 822.02(e), whether public or private, whether operated for profit or not, which is engaged in providing, through its employees, personal care services and/or homemaker services which may be of a supportive nature to persons in their places of residence.

Administrative Rule 809: Home Care Service Provider

  • Home health care provider (HHCP) means any organization or business entity, whether public or private, whether operated for profit or not, which is engaged in arranging or providing, directly or through contract arrangement, one or more of the following services: nursing services, home health aide services, or other therapeutic and related services, which can include but are not limited to, physical and occupational therapy, speech pathology, nutritional services, medical social services, personal care services and homemaker services which may be of a preventative, therapeutic, rehabilitative, health guidance or supportive nature to persons in their places of residence.

State Application for NH Health Care License

Form for Individual Home Care Service Provider (820)

New Hampshire Licensing fees

Contacts at New Hampshire’s Department of Health and Human Services

Links to Federal Programs and Information

Administration on Aging
http://www.aoa.gov/

Agency for Healthcare Research and Quality
http://www.ahcpr.gov/

Centers for Medicare & Medicaid Services (CMS) Home Health
http://www.cms.gov/center/hha.asp

Medicare and Home Care – A CMS Guide

Centers for Medicaid and Medicare (CMS)

CMS Open Door Forums
http://www.cms.gov/OpenDoorForums

CMS Medicare Learning Network
http://www.cms.gov/MLNGenInfo

Home Health Compare Health Quality Initiative
http://www.medicare.gov/HHCompare/Home.asp?version=alternate&browser=IE%7C6%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True

http://www.cms.gov/HomeHealthQualityInits/01_Overview.asp

Home Health Conditions of Participation
http://www.access.gpo.gov/nara/cfr/waisidx_05/42cfr484_05.html

Medicare
http://www.medicare.gov/

Medicare Benefit Policy Manual
https://www.cms.gov/manuals/Downloads/bp102c07.pdf

Medicare Fraud and Abuse
http://www.medicare.gov/FraudAbuse/Overview.asp

Medicare & Medicaid Program Manuals, Transmittals, Program Memoranda
http://www.cms.gov/manuals

National Government Services
http://www.ngsmedicare.com/

OASIS Policy & Technical Information
http://www.cms.gov/OASIS/

OASIS-C Manual
http://nahc.org/regulatory/OASIS-C_August09.pdf

State Operational Manual to Surveyors

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf

Federal Register

http://www.gpoaccess.gov/nara/index.html

General Accounting Office (GAO)
http://www.gao.gov/

National Institute on Aging
http://www.nih.gov/nia/

Occupational Safety and Health Administration
http://www.osha.gov/

Office of the Inspector General (OIG)
http://www.oig.hhs.gov/

Emergency Preparedness

Emergency Preparedness

Centers for Disease Control (CDC)
http://www.bt.cdc.gov/

FEMA Emergency Management Institute
http://www.training.fema.gov/emiweb

FEMA Disaster Preparedness Information
http://www.ready.gov/

FEMA for Kids…information in explaining and preparing children for disaster
http://www.ready.gov/kids

Guidance on Preparing Workplaces for an Influenza Pandemic
http://www.osha.gov/Publications/influenza_pandemic.html

Home Health Care Services Pandemic Influenza Planning Checklist
http://www.flu.gov/professional/index.html

Homeland Security Individual Preparedness
http://www.ready.gov/

National Disaster Medical System
http://www.ww.phe.gov/preparedness/pages/default.aspx

OSHA Guidelines on Pandemic Flu and Worker Protection
http://www.osha.gov/Publications/OSHA_pandemic_health.pdf

Policies & Procedures

Patient and Employee Privacy Information

Privacy Standards
http://www.hhs.gov/ocr/hipaa/

Washington Publishing Co. (Download free HIPAA Implementation Guides)
http://www.wpc-edi.com/content/view/533/377/

Agency for Healthcare Research and Quality; Public Health Preparedness
http://www.ahrq.gov/prep/

Examples of Policies and Procedures

Examples of Policies & Procedures

Patient and Employee Privacy Information

Employers and Health Information in the Workplace

The Privacy Rule controls how a health plan or a covered health care provider shares your protected health information with an employer.

Employment Records

The Privacy Rule does not protect your employment records, even if the information in those records is health-related. In most cases, the Privacy Rule does not apply to the actions of an employer.

If you work for a health plan or a covered health care provider:

  • The Privacy Rule does not apply to your employment records. 
  • The Rule does protect your medical or health plan records if you are a patient of the provider or a member of the health plan.

Requests from your employer

Your employer can ask you for a doctor’s note or other health information if they need the information for sick leave, workers’ compensation, wellness programs, or health insurance.

However, if your employer asks your health care provider directly for information about you, your provider cannot give your employer the information without your authorization unless other laws require them to do so.

Generally, the Privacy Rule applies to the disclosures made by your health care provider, not the questions your employer may ask.

See 45 C.F.R. §§ 160.103 and 164.512(b)(1)(v), and OCR’s Frequently Asked Questions.

For employer issues, contact:

  • Department of Labor: (866) 4-USA-DOL
  • Equal Employment Opportunity Commission: (800) 669-4000

Health Insurance Portability and Accountability Act

HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. The HIPAA Privacy regulations require health care providers and organizations, as well as their business associates, to develop and follow procedures that ensure the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared. This applies to all forms of PHI, including paper, oral, and electronic, etc. HIPAA requires the protection and confidential handling of protected health information including patient health information, demographic information, physical or mental health, health care payment provisions, and client identity. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. Failure to comply with HIPAA can result in civil and criminal penalties (42 USC § 1320d-5).

Examples of HIPAA violations:

  • Improper disposal of patient records; shredding is necessary before disposing of patient’s record.
  • Insider snooping, which refers to family members or coworkers looking into a person’s medical records without authorization. This can be avoided with password protection, tracking systems, and clearance levels.
  • Releasing information to an undesignated party; only the exact person listed on the authorization form may receive patient information.
  • Releasing the wrong patient’s information; through a careless mistake, someone releases information to the wrong patient. This sometimes happens when two patients have the same or similar name.
  • Unprotected storage of private health information, such as a laptop that is stolen. Private information stored electronically needs to be stored on a secure device. This applies to a laptop, thumbnail drive, or any other mobile device.

Scenarios of HIPAA violations:

  • Telling friends or relatives about clients that are under your care
  • Discussing private health information in public areas
  • Discussing private health information over the phone in a public area
  • Not logging off your computer or a computer system that contains private health information
  • Including private health information in an unsecured text or email

Confidentiality of client medical information

Individuals in our care expect us to maintain the confidentiality and security of all their Protected Health Information (PHI). BAYADA does not use, disclose, or discuss client-specific information with others unless the client authorizes the release of his or her information, or we are required or authorized by law to release the information. BAYADA Home Health Care maintains the confidentiality of client medical information and uses appropriate security measures to protect this information, including information contained in client charts. BAYADA also uses appropriate security measures of PHI in all communications.

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