Discussion for the Home Health Sub Committee

1) Home Health Financial status.

2) At what point is Home Health closed? When cash goes to zero? When there is two months worth cash and accounts receivable to cover expenses left?

3) If Home Health is closed down, what does the wind down look like?

4) Home Health building rental contract.

5) Additional CARES Act funding $$ coming?

6) Additional PPP $$ coming?

7) Can KRMC redirect some business to Home Health?

8) Does the Health Department subsidize Home Health?

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Flathead County Health Department

Home Health FY21

Year to Date Summary, October 31, 2020

Total Budget vs. YTD Actual, Cash Basis

Budget Actual Variance

FY21 YTD YTD

Revenue

Private Pay 200,000 59,404 (140,596)

Federal Stimulus - - -

Medicare 1,000,000 292,180 (707,820)

Medicaid 5,000 1,814 (3,186)

Misc - - -

1,205,000 353,398 (851,602)

Expenditures

County Employees 21,985 1,372 20,613

Contracted Services 1,250,700 415,442 835,258

Building Rental 40,700 13,555 27,145

Insurance 4,600 - 4,600

IT Service Charge 3,208 - 3,208

1,321,193 430,369 890,824

Net Increase/(Decrease) (116,193) (76,971) 39,222

Cash Recon

Beginning Cash, July 1, 2020 173,028 FY21 YTD 130,839

Change in Cash, YTD (76,971) FY20 196,797

Ending Cash, October 31, 2020 96,057 FY19 268,968

FY18 291,822

FY17 388,255

Home Health Budget

Average Cash Balance

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Flathead County Health Department

Home Health History FY15 to FY20

Actual Actual Actual Actual Actual Actual

FY15 FY16 FY17 FY18 FY19 FY20

Revenue

Private Pay 194,008 311,895 173,940 270,784 221,725 245,305

Federal Stimulus 64,391

Medicare 1,140,846 980,117 1,110,692 599,385 1,049,753 940,726

Medicaid 7,997 21,937 7,341 37,788 4,242

Misc - - 11,805 10,863 25

1,334,854 1,300,008 1,318,373 888,373 1,309,266 1,254,689

Expenditures

County Employees 138 3,818 6,563 7,571 3,756

Contracted Services 1,235,015 1,366,070 1,163,163 1,086,620 1,235,388 1,237,648

Building Rental 37,275 40,664 40,664 40,664 40,664

Insurance 3,882 3,932 4,227 4,215 4,487

IT Service Charge 23,000 16,500 2,000 2,000 2,000 3,186

Transfer 60,000 40,000 30,000

Bad Debt (33,093) (77,898) 89,151 (124,584)

1,285,059 1,385,829 1,332,728 1,015,489 1,289,838 1,289,740

Net Increase/(Decrease) 49,795 (85,821) (14,354) (127,116) 19,428 (35,051)

Cash 222,486 438,892 329,686 227,364 220,566 173,028

Accounts Receivable, Net 399,310 126,008 206,142 176,337 225,899 239,702

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Flathead County Health Department

Home Health History FY15 to FY20

End of year balances, June 30

FY15 FY16 FY17 FY18 FY19 FY20

Cash 222,486 438,892 329,686 227,364 220,566 173,028

Accounts Receivable, Net 399,310 126,008 206,142 176,337 225,899 239,702

222,486

438,892

329,686

227,364

220,566

173,028

399,310

126,008

206,142

176,337

225,899 239,702

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

FY15 FY16 FY17 FY18 FY19 FY20

Home Health Cash and AR Balances

Cash Accounts Receivable, Net Linear (Cash)

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AGREEMENT

This AGREEMENT, made and entered into this 12th day of December, 2018, by and between the FLATHEAD CITY-COUNTY HEALTH DEPARTMENT, hereinafter referred to as the "Agency", and PARADIGM MANAGEMENT, P.C. hereinafter referred to as "Provider".

WHEREAS, the Provider is a Montana professional corporation providing individual, family, and community health services;

WHEREAS, the Agency is desirous of contracting various home health care services; and

WHEREAS, the Provider has the ability to provide certain of these home health services by the establishment of an efficient management system, the adequate staffing and compensation of staff and the coordination of services.

NOW, THEREFORE, the Agency and the Provider agree as follows:

I.

The Provider will provide certain home health services to the Agency. These services shall include:

1. Skilled Nursing services, including:

Professional assessment of home and social needs, establishment of plans of treatment;

Professional preventive treatment and health maintenance services; and

Coordination of all services included in a patient's plan of treatment when multiple services and/or providers are involved.

2. Physical, Occupational, and Speech Therapies, including:

Professional assessment of home and social needs, establishment of plans of treatment;

Professional preventive treatment and health maintenance services; and

Coordination of all services included in a patient's plan of treatment when multiple services and/or providers are involved.

3. Medical social work including assessment of social needs and community resources.

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4. Program coordination and management.

5. Systematic data collection and storage.

6. Billing and other bookkeeping and accounting services dealing with MEDICARE, MEDICAID, third party (insurance) and private pay claims.

II.

The term of this AGREEMENT is January 1 2019, through December 31, 2020. This AGREEMENT may be terminated in accordance with Paragraph XIII.

The personnel employed by the Provider shall be supervised on a continual basis by their assigned direct superior. Provider is an independent contractor and not an employee or agent of the Agency. Although the provider is an independent contractor, it is understood that the Provider's Administrator and the Agency's Health Officer shall coordinate and cooperate in supervising and directing the overall Home Health Program. Each patient's attending physician will be involved in the monitoring of service and involved in the supervising of the Provider's professional staff.

IV.

The Provider will provide its services in accordance with the plan of treatment established by the patient's physician in conjunction with the Provider's established standard of care.

V.

A description of the Provider's standards for personnel is contained in the Provider's "Personnel Manual" and will be maintained and made available to the Agency upon request. A description of personnel qualifications and functions is also available through the Provider. Monthly formal in-service training will be provided by the Provider to educate and orient staff. Education of staff will be an integral part of the Provider's program.

VI.

The consideration for this AGREEMENT shall consist of payment to the Provider by the Agency ("reimbursement") for services performed for the Agency by the Provider under Paragraph I, et seq., but shall not exceed the limits of allowable and reimbursed expenses provided in Paragraph VII.

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VII.

The Provider will be reimbursed $10,000.00 per month for management services. Ten percent of the quarterly net revenue (profit) will be awarded to the Provider after review and agreement of the Health Officer. If significant losses (as determined by the Agency) occur during any quarterly period, future profits may be adjusted by the Health Officer to recuperate such losses. Reimbursement settlement with the Provider is the responsibility of the Agency. The Agency will reimburse the Provider when the Agency is compensated. The Provider will keep on file and available for review, audit and evaluation, complete accurate, documented and current accounting of all funds received and expended under this AGREEMENT and will not combine those funds with any other fund. Direct costs of the Agency shall not exceed the percentage of such total program costs allowed by MEDICARE AND MEDICAID.

VIII.

The Provider shall comply with all Federal, State and local statutes relative to Title VI of the Civil Rights Act, the Americans with Disabilities Act, the Fair Employment Practices Act, or any other relative law or regulation. The Provider shall maintain approved Affirmative Action and Equal Employment Opportunities Plan.

IX.

The Agency will monitor this AGREEMENT and provide an Administrator (the Health Officer) and a financial officer (the County Finance Director) to implement this AGREEMENT.

X.

The Agency shall retain administration and policy-making authority. The Agency shall establish a permanent committee (Home Health Advisory Committee) to discuss home health policy and issues and submit recommendations to the Agency.

XI.

The Provider shall provide liability insurance coverage subject to the approval of the Agency and under which the Agency is an additional-named insured, in the amount of at least $1,500,000.00 (one million, five hundred thousand dollars).

XII.

This AGREEMENT is non-assignable and non-transferable. Any change

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in structure of the Provider constitutes an assignment and must be preceded by a 90-day notice to the Agency, and approved by the Agency.

XIII.

This AGREEMENT may be terminated as follows:

a. With written consent of the parties;

b. Upon the failure of a party to comply with any term contained herein and upon ninety (90) days written notice of termination to that party;

c. Upon federal funding for the programs herein becoming unavailable or insufficient to operate the program.

d. With thirty (30) days written notice if, at the sole discretion of the Agency, this AGREEMENT fails to result in sufficient revenue, results in excessive expense, or both for the Agency at any time.

Inaction in exercising any option under this AGREEMENT or this section shall not serve as a waiver of the party's rights to exercise the option.

XIV.

The Agency will provide adequate, appropriate and accessible office space.

XV.

Equipment utilized in the program, which is purchased with funds generated by the Home Health Program, is the property of the Agency. Equipment utilized in the program, which is purchased with funds of the Provider, is the property of the Provider.

XVI.

The Provider's Administrator or designee shall have meetings at least monthly with the Health Officer. The Provider shall also make available to the Agency at the Provider's offices the Provider's Annual Financial Report. The Provider will participate with the Home Health Operations Committee of the Agency.

XVII.

The AGREEMENT may be changed only by written amendment containing authorized signatures of the parties. There are no other parts of

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AGENCY

By

illary anson Health Officer

PROVIDER

By

7vi

By Qh asmussen, RN, Partner

Paradigm Management, P.C.

this AGREEMENT outside the terms included in this document.

XVIII.

All books, records and files, which are a part of the operation of this AGREEMENT, are the property of the Agency.

XIX

In the event litigation arises out of the enforcement of this AGREEMENT, the substantially prevailing party shall be entitled to reasonable attorney's fees and costs.

DATED this 12th day of December, 2018.

Cou ney Gwiazdon, PT, Partner Paradigm Management, P.C.

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QuestionsFY21 Home HealthHome Health HistoryChartsInsert from: "Home Health Financial ques.pdf"QuestionsFY21 Home HealthHome Health HistoryCharts