Summer 2018

FEATURE ARTICLE Navigating Third Party Credentialing Systems By Adam Guetzow, Esq., David Alfini, Esq., Aimee Delaney, Esq. OVER THE PAST SEVERAL YEARS, owners and operators of assisted and independent living facilities have increasingly turned to third-party services to review and approve the licensures and other credentials of individuals and/or entities routinely entering their facilities and working directly with their residents. From the home care perspective, this shift towards heightened standards to work within a residential facility as a vendor was primarily a move by the facilities to eradicate unlicensed, uninsured, and under- qualified private duty providers from having unfettered access to residents. This shift, of course, is in line with those states (where home care agencies submit to a licensing body) who have now mandated that referrals made by hospitals, sub-acute rehabilitation centers, and long-term care facilities are made only to licensed agencies. See Illinois Senate Bill 1676; 210 ILCS 55/3.8. While navigating specific facility vendor guidelines and policies and procedures is nothing new for those home care agencies that regularly place caregivers within the four walls of a facility, the for- malization of these requirements as well as stricter enforcement by way of third-party systems presents new challenges and potential legal implications. It is imperative that all home care agencies are familiar with this changing landscape. Community Standards In those facilities that have implemented third-party credentialing systems, the requirements that vendors must meet to be deemed credentialed are standardized. These requirements that are frequently and collectively referred to as "Community Standards," include: • Minimum insurance requirements ($1,000,000 commercial general liability per occurrence, $3,000,000 aggregate; $3,000,000 professional liability aggregate; $500,000 workers' compensation; $1,000,000 auto-liability); • Criminal background check based on 7 year-address history; • Proof of negative TB; and, • A clean 9-panel drug screen. Compliance with the Community Standards does not mean that the home care agency is compliant with local laws. In those states where home care agencies are licensed, these Community Standards may be over or under inclusive when compared to those needed to maintain the state licensure. 10 HCAOA The Voice