1. Home Care and Assisted Living Program
Home Care Matters
Home Care and Assisted Living Program
November 28, 2018

2. Agenda
Time
Topic
10:00-10:15
Welcome and Updates – Cindy Vargas, Lari Anne Mazzitello
10:15-10:30
License Renewal Tips – Neng Vang
10:30-10:45
Survey Information – Jonathan Hill
10:45-11:00
Multi-drug Resistant Organisms – Sean O’Malley, CHAIN
11:00-11:25
Caller Questions – HCALP and CHAIN Team
11:25-11:30
Closing

3. Welcome Home Care and Assisted Living Program (HCALP) Staff
Jonathan Hill, Survey Supervisor
Lari Anne Mazzitello, Operations Coordinator
Neng Vang, Licensing Specialist
Cindy Vargas, Organizational Coordinator
Collaborative Healthcare Association Infection Network (CHAIN)
Sean O’Malley, Epidemiologist
Healthcare-Associated Infections and Antimicrobial Resistance Unit
Welcome

4. Housekeeping
Lari Anne Mazzitello

5. Optional Tagline Goes Here | mn.gov/websiteurl
title
5/22/2019
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5/22/2019
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8. General Updates
Cindy Vargas

9. Communication When Contacting Us
ing scanned documents is better than faxing
When leaving voic messages, speak slowly and include your
HFID
Name
Agency name
Telephone number

10. Reminder for Temporary Licensees
Home care law requires that temporary licensees
Notify the Department of Health when you get your first client
Within five days of starting services
By notifying MDH
You are complying with the law
We can put you on the survey schedule
We can determine if we can grant you a license

11. License Renewal Fees License fees increased by 10% in July 2018.
Use the Revenue Worksheet to calculate revenue from licensed home care services.

12. Fines for uncorrected orders
Invoices for fines are now issued by Financial Management at MDH.
Send your payments of fines to the address on the invoice.
Interest charges will accrue if not paid in 30 days.
Past due fines are sent to the Minnesota Department of Revenue for collection.

13. New Survey Forms Coming Soon!
New forms are being piloted by HCALP surveyors now.
Forms were designed to help
Surveyors be more efficient
Providers conduct self-audits
Watch for them in early January 2019!
We will notify providers via Home Care Updates.

14. Licensing
Neng Vang

15. License Renewal Reminders: Time
Submit early
At least 60 days before expiration of license

16. License Renewal Reminders: Revenue
Do not use decimals
Round to nearest dollar
Do not use commas
Include revenue from licensed home care services
Home Care Revenue Worksheet
$289592

17. License Renewal Reminders: Payment
Pay by e-check
Convenient
No fee
Faster to process
More secure
If you send a check include
Copy of confirmation page
HFID # on check

18. License Renewal Reminders: Application
To ensure your license renewal is not delayed
Complete all required fields
Be accurate and thorough
You only need to return the confirmation page if
Paying by check
Mailing your certificate of insurance
Your agency is Medicare certified (HHA)

19. License Renewal Responsibilities
Licensees
Renew at least 30 days before current license expires
It is illegal to operate without a license
MDH will
Notify licensee if application appears complete OR
Inform licensee if items are missing
Process renewal applications within 60 days of receiving complete application

20. Survey
Jonathan Hill

21. Correction Orders Top 5 Correction Orders Quality Management
Common Home Care Correction Orders (
Comprehensive
Basic
Quality Management
Minn Stat 144A.479 Subd. 3

22. Home Care Matters Statewide Call November 28, 2018
Sean O’Malley, Epidemiologist
Healthcare-Associated Infections & Antimicrobial Resistance Unit

23. Objectives Overview of multidrug-resistant organisms (MDROs)
Overview of carbapenem-resistant Enterobacteriaceae (CRE)
What is CRE? What is carbapenemase-producing CRE (CP-CRE)?
What can we do to prevent spread of MDROs, specifically CRE?
Risk factors for colonization and infection
Prevention efforts
Coordinated approach
Resources

24. Overview of Multidrug-Resistant Organisms

25. How do bacteria develop resistance?

26. CDC Hazard Levels

27. Overview of Carbapenem-Resistant Enterobacteriaceae

28. The Enterobacteriaceae
Family of over 70 species of bacteria
Most common: Klebsiella spp., Escherichia coli, Enterobacter spp.
Enteric organisms
Common cause of healthcare-associated infections
Urinary tract infections
Bacteremia
Pneumonia
Wound infections
Carbapenem antibiotics (e.g., meropenem)

29. Carbapenem-Resistant Enterobacteriaceae (CRE)
Difficult to treat
Pan-resistant strains
New antibiotic development is slow
Resistance can spread
Infections associated with high mortality rates
Prolonged colonization

30. Carbapenemase-Producing CRE (CP-CRE)
Carbapenemase: enzyme that breaks down carbapenems and other antibiotics
CP-CRE: CRE that carry genes for carbapenemase production
Can spread the genes to other bacteria, making them resistant
Can cause major outbreaks in health care facilities
New KPC Containing Bacteria
Susceptible Bacteria
KPC Containing Bacteria
Resistance Gene Transfer XX

31. CP-CRE Cases by Patient Location, 2013-2017

32. MDRO – CRE – CP-CRE
MDRO
CRE
CP-CRE

33. What can we do to prevent spread of MDROs, specifically CRE?

34. Understand Risk Factors
Indwelling devices
E.g. ventilator, urinary catheter, central venous catheter, gastronomy tube
Immunocompromised status
Surgical procedures
Wound management
Prolonged antibiotic exposure

35. Practice Prevention Perform evidence-based infection control practices
Wash hands frequently especially before/after handling indwelling devices, after contact with wounds, and after exposure to blood and bodily fluids
Communicate with healthcare facilities about transfer of patients with MDROs, particularly CRE
When possible, dedicate specific equipment to patients colonized or infected with MDROs
Ask questions!
Sean O’Malley:
Infectious Disease Epidemiology, Prevention and Control Main Line: (651)

36. Implement Coordinated Approach

37. Resources MDH Resources: CDC Resources: CRE Toolkit:
Antimicrobial Resistance and Stewardship (
Infection Prevention and Control Resources (
CDC Resources:
Antibiotic/Antimicrobial Resistance (
Carbapenem-resistant Enterobacteriaceae in Healthcare Settings (
Multidrug-resistant organisms (MDRO) Management (
CRE Toolkit:
Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae ( toolkit/index.html)

38. Thank you! Questions? Sean O’Malley sean.omalley@state.mn.us
(Main Line)

39. Home Care and Assisted Living Team
Q & A Time
Home Care and Assisted Living Team

40. Next Home Care Matters Call
Mark Your Calendars
Next Home Care Matters Call
Wednesday, February 20, 2019
10:00 – 11:30 am

41. Thank you for participating in Home Care Matters!