Colorado Health Care 
Training and Consulting

August 8, 2018


"Action is the foundational key to all success." 


- Pablo Picasso


Each year CHC provides training and consulting to hundreds of agencies, their staff of nurses, therapists, personal care providers, and aides as well as to family and other caregivers who provide in-home services to the infirm, chronically ill and disabled  to improve care, quality and safety. 

 ON JANUARY 1, 2019 

When will the Department mandate EVV

The Department is still scheduled to implement the Sandata Santrax solution January 1, 2019. Implementing the system as scheduled will allow additional time for EVV users to pilot the new solution before the mandate is effective January 1, 2020. The Department is working on a delayed EVV timeline and will inform stakeholders of details over the next four to six weeks. It is the Department's intention to use extra time to continue stakeholder engagement, extend the pilot program, and implement a soft roll-out. The Department currently hosts a monthly EVV stakeholder meeting and four subcommittees: System, Participant Direction, Privacy, and Training/Communications. These groups will continue to meet and work towards successful EVV implementation. The Department encourages stakeholders to participate in these meetings. Additional information around EVV implementation and the updated timeline will be communicated through this Memo Series, emails to our EVV distribution list, and stakeholder meetings. 

Join the HCPF EVV distribution list by emailing 

Home Health Compare Quality Charts Updated
The Home Health Compare results were updated on July 25, 2018.

Patient survey star ratings 
HHCAHPS (Home Health Consumer Assessment of Healthcare Providers & Systems) star ratings help consumers quickly and easily assess the patient experience of care information provided on Home Health Compare. 

Easily compare home health agencies using a 5-star scale, with more stars indicating better quality care.

To calculate the star ratings, HHCAHPS Survey information from one home health agency is compared to that from others. More stars indicate better quality care than fewer stars.  
To learn more about the HHCAHPS Survey, please visit

For the Quality of Patient Care measures, 12 measures improved, 1 worsened, and 1 remained the same. As with last quarter, improvement in bed transfer saw the most improvement of 1.3%. Improvement in management of oral medications improved by 1.2%. Multifactor fall risk assessment conducted saw no change and Depression assessment conducted worsened by 0.1%. (Data Collection October 1, 2016 - September 30, 2017).

Acute care hospitalizations improved this quarter, from 15.9% to 15.8%, while Urgent, unplanned care in the emergency room remained at 12.9%. (Data Collection October 1, 2016 - September 30, 2017).

The national average for the Quality of Patient Care Star Rating remained at 3.5 stars. The percentage of agencies with 3 and 4.5 stars declined, and the percent of agencies with 2 and 5 stars increased.
HHCAHPS measures also updated and the national averages remain the same. The data collection period for these measures and the Star Ratings is January 1, 2017 - December 31, 2017.

Quality measures
Home Health Compare shows how often each home health agency used best practices when caring for its patients and whether patients improved in certain important areas of care. These indicators of home health care quality are also known as 'quality measures.'
The quality measures are divided into these categories:

To see where the 5 star agencies are located, look at the map below.

On-Line OASIS training videos

OASIS C2 Basics (One Session): Course ID 1066908
This beginning three-hour class is how to get started with OASIS C2.

OASIS C2 Item-by-Item (2 Sessions): Course ID 1066909
This practical application class reviews item-by-item data set completion. We will follow Mrs. Green's assessment, which will require two sessions to complete. Attendance at both sessions is required to complete this class.

OASIS C2 Quality Measures (One Session): Course ID 1066910
This course assumes familiarity with the OASIS C2 Item Set, covering more advanced content and application.

To see additional session details and register for on-site attendance for one of these offerings:
1. Go to
2. Log in to your existing TRAIN account, or new users click "Create an Account"
3. Once you've logged in, or created an account, Search (top right) for the appropriate Course ID. (See above for desired training)
4. Click link for desired course.
5. Click the "Registration" tab.
6. Click the "Register" button for the session you wish to attend.
7. Remember to register separately for each desired course.
Questions?: Please email

CDPHE-approved Basic 8-hour Administrator Training for  A ll agency types 
with Connie McWilliams, MBA, CHC president with 20 years of experience as owner-operator of an accredited Medicare-certified agency.
LIVE PROGRAM offers 4 CEUs each day
September 11 & 12, 10:00 am to 3:00 Pm

 This course provides compliance with both  Annual Training and Initial Training   required  of all Administrators, Managers & alternates.

HCBS or IHSS Home Care: The Standards & Ongoing Compliance 

8/9 HCBS

 Laura Neill, former CDPHE Surveyor and Case Manager (

Non-medical Management & Supervisor
Training Parts I & II 
Part 1:  8/23
Part 2:  8/30

Join Laura Neill (, former CDPHE Surveyor and Case Manager.


eLearn available 24/7 
24/7 - eLearn Care about Care coordination
24/7 - eLearn Care about Privacy, Confidentiality & HIPAA
24/7 - eLearn Behavior Management of the client with Dementias
Live and Online

8/7 Agency Oversight & Operations
8/9 HCBS
8/14 Quality Management Program
8/16 IHSS
8/21 Emergency Preparedness
8/23 Non-medical Management/Supervision Part 1
8/28 Complaint & Incident Process Part 1
8/30 Non-medical Management/Supervision Part 2
9/11 & 12 LIVE Basic 8-hour Administrator Training
CEU Consulting at your offices by appointment & 4-hour minimum.


eLearn available 24/7 $100

Behavior Management of the Client with Dementia or Cognitive Disorders

Registrants will learn skills and tools necessary to provide care and services to clients with cognitive and memory impairments.

Elder Abuse & Financial Exploitation

Elder Abuse and Financial Exploitation

In Colorado, more than 4,000 incidents of adult abuse, exploitation or neglect are reported each year to local county departments of social services and long-term care ombudsmen. Many more go unreported. The victims are at-risk adults age 18 or over who due to age or disability are unable to protect themselves and have no one to protect them. For many, the abuse, exploitation or neglect is caused by a caregiver or a member of their own family. As of July 1, 2014 elder abuse is a mandatory reporting incident in Colorado.

AARP ElderWatch

AARP ElderWatch Project fights the financial exploitation of older Americans in the state of Colorado through collection of data, extensive outreach and education, and the provision of technical assistance.

Adult Protective Services
Adams County - 303-227-2353
Arapahoe County - 303-636-1750
Boulder County - 303-441-1441
Broomfield County - 720-887-2271
Denver County - 720-944-2994
El Paso County - 719-444-5755
Jefferson County - 303-271-4673
Larimer County - 970-498-7770
Mesa County - 970-248-2888
Pueblo County - 719-583-6853
Weld County - 970-352-1551

If you suspect mistreatment or self-neglect of an older adult, you can report it to APS who can intervene on the person's behalf. To make a report of elder abuse or incapacity, you must call the county department of social services where the individual lives. If you do not live in one of the above listed counties, click here to view a list of all county departments of social services.

Colorado Coalition for Elder Rights and Abuse Prevention
789 Sherman Street, Suite 250 
Denver, Colorado 80230 USA 
Email:  -

Denver Center for Crime Victims - Elderly and Disabled Services
The Elderly and Disabled Program provides crisis intervention and support services to individuals who are disabled and/or 60+ who are victims of crime, from the crisis intervention stage through prosecution and post-trial recovery.

U.S. Securities and Exchange Commission
The SEC has many resources to help seniors be sure they are investing wisely, including broker licensure checks, tips on smart investments, how to report fraud and how to protect yourself from scams.


Chronic conditions like diabetes, asthma, depression and heart disease, and life-threatening cancers, can significantly impact the lives and lifestyles of those affected, leading to high health care costs, and sometimes premature death.  

New interactive condition prevalence reports available from the CO APCD help identify which parts of the state and which patient demographics have higher prevalence of chronic conditions. 

To call out some of these metrics, the Insights document  summarizes some of the key disparities. A few highlights include:
  • Of the conditions studied, Hypertension is the most frequently diagnosed among insured Coloradans (12% of all Coloradans have a Hypertension diagnosis)
  • Over 5% of all Coloradans had a Depression diagnosis in 2015, and Depression diagnoses increased 26% across all payers since 2012
  • In general, Asthma, Depression, and Diabetes Type II rates are highest in Southeast Colorado
  • Central Mountain counties, including Gunnison, Pitkin and Eagle have some of the lowest prevalence of most conditions including Hypertension, Diabetes, COPD and CHF.

eLearn Courses 
2 CEUs
available 24/7
( A ll agency types)
CDPHE-approved Care about Care Coordination
- 2 CEUs $100

CDPHE-approved Privacy & Confidentiality: C are about HIPAA-2 CEUs $100

These eLearn courses are available 24/7 and offer clear learner progress indicators and unlimited replays of course material. Resume learning exactly where you left off, on your mobile, tablet, laptop or any device.  

Consulting CEUs

Agency-centered Training
CEU Consulting 
4 CEUs and up

  • Quality Management Program
  • Complaint, Incident, Occurrence, Grievance Log
  • Provision of Skilled Care & Services
  • Annual Evaluation

eLearn Program: Why Home Care Should Care 
With $2.8 billion being spent on healthcare hacking breaches during 2016, and 81% of IT leaders citing data security as a top business goal, security in healthcare has never been more important.
Who's Planning for the End of Life in Colorado?

More than two thirds of Coloradans over the age of 65 have an advance directive -- a written plan laying out their preferences for end-of-life health care. Colorado's older adults are more likely to have a plan than those in the country as a whole. 

Having a plan matters: Advance directives are associated with positive health outcomes and reduced spending. That's not to mention less quantifiable benefits that come along with having your wishes honored at the end of life.  

CHI's newest report examines just who in Colorado has an advance directive and other information about end-of-life health care and decision making. It's based on a brand-new set of questions included in the 2017 Colorado Health Access Survey.

Policy analyst Liana Major writes about why advance directives can be so important in a new blog

Read the new report on advance directives and end-of-life planning


9 am - 11 am
2 CEUs

8/14 is closed/filled Quality Management Program

8/21 Emergency Preparedness

8/28 Complaint & Incidents Part 1

9/4 Complaint & Incidents Part 2

Join Jennifer Windram, RN, BSN and former CDPHE Surveyor.

Handbook of Home Health Standards, 6th Edition

The new! 2018 6th edition of the best-selling widely-used Handbook of Home Health Standards: Quality, Documentation, and Reimbursement is now available! 

New sections in the Care Guidelines include "Comfort Considerations", "Queries for Quality" and "Caregiver Considerations". 

A practical patient sample with a completed POC and a corresponding OASIS is presented for learning and clarity purposes. The "Evidenced-Based and Other Resources for Practice and Education" sections have been updated and expanded. 

This "Little Red Book" is all about assessment, care planning, patient/caregiver engagement and supporting quality, safety and improved patient outcomes. Favorite sections include foundational concepts of coverage, documentation and standards to support compliance, reimbursement, and value. 

The Handbook supports the delivery of efficient, standardized, interdisciplinary quality care and from an evidence-based practice perspective. The Handbook provides tips and strategies for success in areas of common deficiencies. Chapter 7 of The Medicare Benefit Policy Manual is included as well as the practical information needed to succeed in home care. 

Whether you are a visiting nurse, a clinical supervisor or manager, therapist, a QAPI team member or work in sales or administration-this Handbook explains what is needed to be successful in your daily work and operations.


Breaking misconceptions about IHSS

IHSS program rules waive certain provisions of the Colorado Nurse Practice Act and Colorado Nurse Aide Practice Act to allow this service to be provided to people who otherwise would be living in a nursing home rather than independently, in their own residence.  A Registered Nurse provides oversight 
not actual care.
IHSS services will be allowed as a supplemental benefit for Medicare Advantage (MA) Plans in 2019 forward.

IHSS agencies are required to be licensed as home care agencies by CDPHE, and as licensed home care agencies, they must adhere to the standards of care established by
the Colorado State Board of Health, which is located in CDPHE.

The Medical Services Board, located in HCPF, is charged with adopting rules for the implementation and administration of IHSS for Medicaid reimbursement, which it has 
done. HCPF has delegated the monitoring of the standards of care to CDPHE.

An IHSS agency is different from other Class B agencies since it must contract with or employ a licensed healthcare provider, such as a registered nurse, to verify the skills  and competencies of attendants. This is not necessary for other Class B agencies since they do not provide healthcare services

For one, an IHSS agency is defined by statute as providing independent living core services, which include:
· Information and referral services;
· Independent living skills training;
· Peer counseling, including cross-
disability peer counseling; and
Individual and systems advocacy.
These responsibilities are not required of other home care agencies

Another reason IHSS agencies are different from other home care agencies is because IHSS participants may select and train their own attendants, and certain provisions contained in the Nurse Practice Act and the Nurse Aide Practice Act are 
waived. This enables attendants, who may be lay persons, to provide some services (such as wound care, catheter irrigation, and medication administration) that might otherwise be considered the practice of nursing. 
For example, an attendant for someone with cerebral palsy may not be a licensed nurse, but he or she may be trained to provide gastronomy tube feedings in order to prevent malnourishment. RN is for oversight not actual care.  

By participating in IHSS, individuals with significant health care needs are able to keep the cost of care down by employing a lay person rather than a skilled nurse. Otherwise, the cost of care at home or in the community may exceed the limits set by Medicaid, and the individual would be required to move into a nursing home.

Unlike other Class B agencies, an IHSS agency is required to contract with or hire a licensed healthcare professional, who is in charge of, among other things, verifying the skills and competency of attendants, consulting with clients in case medical issues arise, and assuring attendants are following care plans.
For a home care agency to provide IHSS, it must have at least a Class B license and have basic HCBS certification. 
Although IHSS attendants may provide health-related services, they only provide assistance with specific health maintenance tasks that they are trained to do by the clients and verified by the IHSS agencies. I HSS attendants do not provide skilled nursing care to a general population as a nurse in a Class A agency does.

IHSS agencies must renew their home care agency licenses every year, and CDPHE conducts periodic surveys to ensure that IHSS agencies are in compliance with the home care standards and, per interagency agreement with HCPF, 
current HCBS and IHSS regulations.
Individual Participation in IHSS: In order to receive long-term care through Medicaid, individuals must go 
through a 
regional case management agency. Colorado has 23 case management  agencies, called Single Entry Point (SEP) agencies, which determine eligibility for long-term care 
clients who may be eligible for IHSS. A case manager works with an applicant to determine the need for long-term care services and select a long-term care provider. The cost of IHSS cannot be more than the cost of placement in a long-term care facility.

CHC Consultant Laura Neill is the resident expert on IHSS.

Solve Complex Problems by Expanding Your Thinking

Too many leaders approach complex problems with either-or thinking: The answer is right or wrong, good or bad, win or lose. 

To cultivate a nuanced perspective, challenge your understanding of the problem. Ask yourself, "What am I not seeing here?" and "What else might be true?" Don't seek out answers that just confirm what you already know. It's also helpful to tackle this kind of challenge first thing in the morning, when your mind is fresh. Spend at least an hour on it without interruption. The dedicated time ensures that you give a complex issue the attention it needs - attention that might otherwise be consumed by less intellectually demanding tasks. And as you work, pay attention to how you're feeling. Embracing complexity is an emotional challenge in addition to a cognitive one. You'll need to manage tough emotions like fear and anger and get yourself out of flight-or-fight mode so that you can think more expansively.

Adapted from "What It Takes to Think Deeply About Complex Problems," by Tony Schwartz