Missouri CDS Employment Application

The Company, Advantage Home Care (includes Advantage In-Home Services, LLC , Advantage Consumer Directed Services, LLC and TPC Advantage, LLC) will obtain background checks as a consideration of employment that may include, but not limited to: employment and education verifications, social security verification, criminal history, civil history, consumer reports that include nationwide background checks, sex offender registry, highway patrol records, Department of Motor Vehicle (DMV) records, finger prints, Division of Homeland Security, public records of any kind, personal interviews and other screenings. As required by regulation, Advantage Home Care requires applicants to be registered with various state registrars prior to an employment offer being made. As allowed by law, applicants and employees are required to disclose all aliases, social security numbers and criminal convictions, findings of guilt, pleas of guilt and pleas of nolo contendere except in minor traffic violations. Applicants applying to work in the state of Illinois are not obligated to disclose sealed or expunged records of conviction or arrest, nor if they exist. All employees are required to complete an I-9 at hire and provide proof of identity. Advantage Home Care participates in E-Verify through the Division of Homeland Security. Employment is contingent upon the results of thorough background checks pursuant to federal and state regulations and Company policy. Persons found guilty of a prohibited offense as defined by regulation, regardless of adjudication or a plea of nolo contender, are not eligible for employment. Other offenses and findings may require a formal waiver to be obtained before employment will be considered as defined by regulation or make a person ineligible for employment per company policy and/or company discretion. Background checks are conducted prior to hire and throughout employment.

CONFIDENTIALITY, NON-DISCLOSURE AND NON-SOLICITATION AGREEMENT

This Confidentiality, Non-Disclosure and Non-Solicitation Agreement (“Agreement”) is made and entered into in the State of Missouri by and between TPC Advantage, LLC, a Missouri limited liability company and all related companies (collectively, “Advantage” or “Employer”) and the “Employee” named in this application as of the date the “Employee” provided their acknowledgment of the agreement contract terms.

WHEREAS, Employee acknowledges Employer is engaged in a specialized and highly competitive business providing, among other services,

WHEREAS, Employer desires to employ (or continue to employ) Employee and Employee desires to be employed (or continue to be employed) by Employer as an In Home aide and/or Consumer Directed Services Attendant and

WHEREAS, Employee acknowledges that the execution of this Agreement is an express condition of Employee’s employment (or continued employment) with Employer; and

WHEREAS, no contract regarding the length of employment is created by this Agreement and the employment relationship between Employer and Employee is terminable at the will of either party.

NOW, THEREFORE, in consideration of Employee’s employment (or continued employment) with Employer, and for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, Employer and Employee hereby agree to execute and be bound by this Agreement as follows:

1. DEFINITIONS: In this Agreement:
Client or Clients means any individual, couple, group of individuals, or other entity that has been solicited, contacted, or served by Employer at any time during the twenty-four (24) month period prior to the discontinuation of Employee’s employment with Employer.
Referral Source means any individual, proprietorship, partnership, corporation, association or other entity that has referred Clients to Employer at any time during the twenty-four (24) month period prior to the discontinuation of Employee’s employment with Employer.
Competing Business means any individual, proprietorship, partnership, corporation, association or other entity other than Employer which: (i) is engaged in, or is about to be engaged in, non-medical home care service, skilled nursing visits, personal care services, attendant services, companion services, pediatric care, consumer directed care, house cleaning, grooming, meal preparation, respite care, and medication assistance and reminders.

Trade Secrets mean any technical information and business information that generally facilitates the sale and performance of Employer’s services, increases revenues, or provides an advantage over Employer’ competitors and is not generally known.
Know-How means all factual knowledge and information related to Employer’ business which is not capable of precise, separate description but which, in accumulated form, after being acquired as a result of trial and error, gives to the one acquiring it the ability to produce and market something which one would otherwise not have known how to produce and market with the same accuracy or precision necessary for commercial success, provided, however, that such knowledge and information is not in the public domain or readily available to any third party other than a limited number of persons who have agreed to keep that information secret.
Confidential Information is information acquired by Employee in the course and scope of his or her activities for Employer or to which Employee is, was or will be exposed to by Employer that is designated by Employer as “confidential” or that Employer indicates through its policies, procedures, or other instructions, or by this Agreement, should not be disclosed to anyone outside Employer except through controlled means. Confidential Information need not be a Trade Secret, Intellectual Property, or Know-How to be protected under this Agreement. The parties to this Agreement specifically agree that, regardless of its affect on trade secret status, the controlled and limited disclosure of Confidential Information to third parties for legitimate business purposes and the availability of the Confidential Information to others outside Employer through independent investigation and effort will not remove it from protected status as Confidential Information under this Agreement if Employee was first entrusted with the Confidential Information while employed by Employer. “Confidential Information” includes, but is not limited to, any and all trade secrets and/or confidential, financial or business information of Employer, or any of its direct or indirect subsidiaries or affiliates, including, but not limited to, (i) names, addresses, phone numbers, e-mail addresses, w-2 information, work history, qualifications, work performance and contact information for Employer’s employees, (ii) names, addresses, telephone numbers and e-mail addresses of customers/clients (and key contacts related to customers/clients), and other business information concerning the level of business provided to any such customer/client, the business preferences and requirements of any such customer/client, prices charged such customer/client, or other business information which otherwise would be of assistance in marketing, serving and/or retaining any such customer/client, (iii) financial statements or reports, marketing or business plans, marketing or business techniques, market analysis, marketing or business plan development material, management information system material, Employer’s statistical information, prices charged customers, quality assurance data, financial status, profits, profit margins, accounts receivable and payment information, and other financial information of or concerning Employer, or any of its respective direct or indirect subsidiaries or affiliates, (iv) marketing and bidding information, rates, price and quotation techniques and methods, sales volumes and profits, margins, marketing plans, strategies and projections, business methods, forms and procedures, (v) operating procedures and manuals, forms, policy manuals, customer/client evaluation procedures, standard of care and outcome measurement data, and companies and contacts from whom Employer, or any of its respective direct or indirect subsidiaries or affiliates obtains various products for sale, resale and marketing, (vi) lists of customers/clients, including but not limited to, any such information maintained on any computer system or data base, (vii) computer software or other data, (viii) accounting information, cost information, discount information, pricing and pricing structure, source codes and/or object codes, technical data, product specifications (of Employer, or any of its respective direct or indirect subsidiaries or affiliates and of any customer of any such business or entity), sales and other records, process technology, lists of customers, and computer software systems and programs, (ix) trade secrets, software, object code, manuals, product design, plans, financial information, software designs and programs, sales and customer information, and other information of Employer, (x) personnel and internal business records and plans, and other information that may not be known generally or publicly outside Employer, or any of their respective direct or indirect subsidiaries or affiliates which gives such business or entity an advantage over its competitors who do not have access to or know or use it, and (xii) other information concerning Employer and customer projects, proposals, financial and operating data.
Company Information means Trade Secrets, Know-How, and Confidential Information (recognizing that certain information and material will fall into multiple categories).

2. CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT: Employee recognizes and acknowledges that Employer has a legitimate business interest to keep certain information confidential at all times. Employee further acknowledges that Employer’s Confidential Information, including, but not limited to, referral sources, clients, and customers of Employer who utilize or are serviced by Employer’s programs as well as the employees and staff who are employed by Employer, are valuable and unique assets of the Employer’s business and were acquired and developed at considerable expense to the Employer. Effective immediately and at all times thereafter, Employee shall hold in strictest confidence and shall not disclose to any person, firm, corporation, partnership, agency, commission, institution or other entity, without the express prior written authorization of the President of Employer, or any other designee selected by the President of Employer, any Confidential Information, Trade Secrets, Know How and/or Company Information relating to any business of Employer.
(a) By virtue of Employee’s employment by Employer, Employee will become familiar with and possess documents and information which are Confidential Information, Trade Secrets, Intellectual Property and/or Company Information, as defined in this Agreement, and Employee will become personally acquainted with certain Referral Sources and Clients of Employer. Employee further acknowledges that Employee will acquire a special relationship with many of the Employer’s Clients and Customers through this employment. Employer and Employee specifically agree and acknowledge that any and all Confidential Information or Trade Secrets provided by Employer or otherwise obtained by Employee during the term of this Agreement is proprietary, unique and commercially sensitive in nature, represents in many instances advanced and state of the art technology, and has been developed over time and reflects a substantive investment by Employer. Employee further acknowledges that Confidential Information and Trade Secrets provided by Employer are not matters of public or general knowledge in the industry and that Employer derives economic value (whether actual or potential) from such information. Employee acknowledges Employer has maintained substantial secrecy concerning the Confidential Information and Trade Secrets and that absent disclosure by Employer to Employee, Employee could not otherwise have readily ascertained by proper means, and/or have acquired knowledge of such confidential or proprietary information and trade secrets.
(b) In the event of termination of employment for any reason, Employee shall immediately deliver to Employer all of Employer’s property, including, but not limited to, all copies and electronically stored versions of any Employer’s property, containing or relating to any Confidential Information, Trade Secrets, and/or Company Information, as defined in this Agreement, and all other business records as well as all other Employer’ property in Employee’s possession and over which Employee has control.
(c) Employee will not, without the prior written consent of Employer, during or at any time after the period of his/her employment by Employer, use for his/her own use or any other’s use or benefit, any Confidential Information, Trade Secrets, and/or Company Information obtained during, after or as a result of employment by Employer.
(d) Employee acknowledges and agrees that Employee will have access to Confidential Information (including the information contained in this Agreement) and that Employee shall not in any manner, directly or indirectly, disclose or divulge Confidential Information to any other person, firm, corporation or other third party for any use or purpose, except as required by law or with the express written authorization of Employer.
(e) The Confidentiality and Non-disclosure obligations and covenants expressed herein shall remain in full force and effect during Employee’s employment with Employer and during or at any time after the period of Employee’s employment with Employer.
(f) Employee understands and acknowledges that any violation of this Section 2 is grounds for immediate termination.

3. NON-SOLICITATION AGREEMENT:
(a) Employee acknowledges that, along with access to Employer’s Confidential Information, Employee will acquire a special relationship with many of the Employer’s Clients, Customers, and employees through employment with the Employer.
(b) During Employee’s employment by Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee shall not, without the prior written consent of Employer, in any manner, directly or indirectly, either individually or as an employee, owner, partner, consultant, shareholder, director, officer or agent of another, for his/her own benefit or on behalf of any person, firm, partnership, entity or corporation, solicit, recruit, hire, retain, employ, create a business relationship with, or endeavor to solicit, recruit, hire, retain, employ or create a business relationship with any current employee of Employer or any former employee of Employer who was employed by Employer at any time during the one year period (365 days) immediately prior to the discontinuation of Employee’s employment with Employer.
(c) Employee further agrees that during his/her employment with Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee will not directly or indirectly, on Employee’s own behalf or on behalf of any third party, or as a sole proprietor, joint venture, partner, employee, officer, director, consultant, shareholder, investor, or otherwise solicit the business of any of Employer’s Clients, customers or referral sources, or contact such Clients, customers, or referral sources for any business purpose that is competitive with Employer’s business.
(d) Employee further agrees that during his/her employment with Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee will not directly or indirectly, on Employee’s own behalf or on behalf of any third party, or as a sole proprietor, joint venture, partner, employee, officer, director, consultant, shareholder, investor, or otherwise encourage any of Employer’s Clients, customers or referral sources (i) to modify their business relationship with Employer or (ii) not to establish or not renew their business relationship with Employer.
(e) Employee understands and acknowledges that any violation of this Section 2 is grounds for immediate termination.

4. ACKNOWLEDGEMENTS. Employee acknowledges and agrees that Employee has the experience, knowledge and capabilities to obtain employment notwithstanding the restrictions in Section 2 and Section 3 and thus Employee has a means to support himself or herself and Employee’s dependents other than by engaging in the activities restricted by the terms of Section 2 and Section 3 and that the terms of Section 2 and Section 3 will not impair such ability. Employee further acknowledges and agrees that enforcement of this Agreement through an injunction will not prevent Employee from earning a living and supporting himself or herself. Employee also acknowledges and agrees that this Agreement does not constitute a contract of employment, Employee’s engagement with Employer is at-will and may be terminated at any time for any or no reason, and nothing herein shall be interpreted as providing Employee the right to continued employment by Employer or provide Employee any right to any compensation or payment upon Employee’s termination.

5. GOODWILL. Employee acknowledges that Employer has developed, over a period of time, and will continue to develop, significant relationships and goodwill between itself and its Clients and Referral Sources by providing superior services. Employee further acknowledges that these relationships and this goodwill are a valuable asset belonging solely to Employer. Employee further acknowledges that any business relationship that he or she brings or has brought to Employer will belong to and will inure to the benefit of Employer after Employee begins his or her employment. Finally, Employee acknowledges that the responsibility to build and maintain business relationships and goodwill with current and prospective Clients and Referral Sources creates a special relation¬ship of trust and confidence between him or her, Employer, and its Clients and Referral Sources. Employer promises to permit Employee to use its goodwill with its current and prospective Clients and Referral Sources to enable Employee to perform his or her duties for Employer.

6. RETURN OF EMPLOYER PROPERTY Employee acknowledges that all written records, databases, CDs, DVDs, disks and other electronic storage media containing information relating to Employer business, including, without limitation, memoranda, notes, correspondence, reports, manuals, books, papers, letters, Client profile data, Client lists, contracts, software programs, drafts, and other documentation (whether in draft or final form, and whether in paper or electronic format), marketing plans, and other sales, financial or technical information relating to Employer’s business, and any and all other documents containing Company Information furnished to Employee by any representative of Employer or otherwise acquired or developed by him or her in connection with his or her association with Employer (collectively, "Recipient Materials") shall at all times be Employer’s exclusive property. Within twenty-four (24) hours of the termination of his or her employment, Employee promises to return any Recipient Materials that are in his or her possession, custody or control, regardless of whether such materials are located in Employee’s office, home, automobile, personal computer, electronic storage media or elsewhere. Employee also shall authorize and permit Employer to inspect all computer drives and electronic storage media used or maintained by Employee during his or her employment and, if necessary, to permit Employer to delete any Recipient Materials or Company Information contained on such drives or storage devices. Additionally, within twenty-four (24) hours of the termination of his or her employment, Employee agrees to return to Employer any equipment or other tangible property which Employee received from Employer during his or her employment, including, but not limited to, desktop and laptop computers, printers, monitors, cellular telephones, pagers or other personal com¬munication devices, credit cards, access cards, security cards, keys and employee manuals which are in Employee’s possession, custody or control, and shall disclose to Employer any and all passwords or codes required to gain access to such devices.

7. REMEDIES FOR VIOLATION: Employee acknowledges that the damages which will be suffered by Employer by a breach of any term or provision of this Agreement may be continuing and irreparable, but will also be difficult or impossible to ascertain in money or money’s worth. Consequently, in addition to any action at law for damages, Employee agrees that Employer may have equitable relief, including specific performance and injunctive relief, including temporary restraining orders and preliminary, permanent and mandatory injunctions, to ensure and enforce his/her performance of such obligations. If such action becomes necessary, Employee further agrees to pay the attorneys’ fees and costs incurred by Employer in the enforcement of these contract provisions, whether or not litigation is initiated.

8. NON-WAIVER: Employer’ failure to exercise any of its rights in the event Employee breaches any of the separate and distinct promises in this Agreement shall not be construed as a waiver of such breach or prevent Employer from later enforcing strict compliance with any and all promises in this Agreement.

9. BINDING EFFECT: This Agreement shall be binding upon and shall inure to the benefit of Employer, its successors and assigns.

10. ASSIGNMENT: This Agreement can only be assigned by Employer.

11. MODIFICATION: This Agreement contains the parties’ complete understanding regarding the subject matters contained herein, and there are no other agreements, oral or written, pertaining to the subject matters of this Agreement. Any amendments to this Agreement must be in writing and signed by the parties.

12. DISCLOSURE OF EXISTENCE OF AGREEMENT: In order to preserve Employer’s rights under this Agreement, Employer may advise any third party of the existence of this Agreement and of its terms and may provide such third party copies hereof, and Employer shall have no liability for doing so. Employee shall notify each subsequent employer or person or entity using the services of Employee at any time within two (2) years following the termination of Employee’s employment with Employer of the existence and provisions of this Agreement. Employee shall also notify Employer in writing of the name, principal business address, primary area of business, and any area of business competitive with the business of Employer of each person or entity by whom Employee is employed or otherwise engaged to provide services at any time within two (2) years following the termination of Employee’s employment with Employer.

13. PRIOR AND/OR PRESENT EMPLOYMENT: Employee represents and warrants to Employer that Employee is not a party to any agreement containing a noncompetition provision or other restriction with respect to (a) the services or business that Employee is required to perform or conduct for Employer or (b) the disclosure or use of any information which directly or indirectly relates to the nature of the business of Employer or the services to be rendered by Employee to Employer. Employee further certifies that he/she has not disclosed or used, and will not disclose or use, during Employee’s employment by Employer, any confidential information that Employee acquired as a result of any previous employment or under a contractual obligation of confidentiality before Employee’s Employment by Employer.

14. INTERPRETATION, JURISDICTION & VENUE: This Agreement shall be interpreted, governed and construed according to the laws of the State of Missouri without reference to conflict of law principles and notwithstanding the place of execution hereof or the performance of any acts under this Agreement in any other jurisdiction. Employee agrees that the State of Missouri bears a substantial relationship to the parties and the transaction between the parties under this Agreement and each party consents to the personal jurisdiction of the state and federal courts located in the State of Missouri for purpose of any suit, action or other proceeding arising out of this Agreement. Employee waives any argument that venue in any such forum is not convenient. Employee and Employer each agrees that the venue of any litigation initiated by either of them in connection with this Agreement shall be in either the Circuit Court of St. Louis County, Missouri, or the United States District Court for the Eastern District of Missouri.

15. HEADINGS: Paragraph headings are for reference purposes only and do not restrict or limit in any way any subject matters contained in this Agreement.

16. ACKNOWLEDGEMENT: BY SIGNING THIS AGREEMENT, EMPLOYEE ACKNOWLEDGES THAT HE/SHE HAS READ THE AGREEMENT, THAT HE/SHE UNDERSTANDS THE AGREEMENT AND INTENDS TO FULFILL EACH AND EVERY ONE OF THE PROMISES IN THIS AGREEMENT, THAT EMPLOYEE UNDERSTANDS THAT THIS IS A LEGALLY BINDING AGREEMENT, THAT EMPLOYEE HAS RECEIVED A COPY OF THIS AGREEMENT AND THAT EMPLOYEE UNDERSTANDS, ACKNOWLEDGES AND AGREES THAT THE PROMISES MADE HEREIN ARE REASONABLE AND NECESSARY TO PROTECT EMPLOYER’ LEGITIMATE BUSINESS INTERESTS.

IN WITNESS WHEREOF, this Agreement has been executed as of the date the employee acknowledged their agreement.

EMPLOYEE: I understand that by acknowledging this agreement in the online onboarding paperwork, I am agreeing to the terms listed in the agreement.

1. Home is a place where most of us feel safe and comfortable. For some elders, however, home is not safe due to elder abuse.

2. Elder Abuse: The mistreatment of an older person by someone who has a relationship with the elder. It could be a spouse, adult child, friend, neighbor or caregiver.

3. According to the National Center on Elder Abuse, more than two thirds of abusers are family members.

4. The results of elder abuse can be seen in unnecessary suffering, injury and violation of the human rights of the elderly.

5. Elder abuse can happen to anyone by anyone regardless of his or her social class or ethnic background.

6. Elder abuse is very complex:
• Generally, a combination of factors contributes to elder mistreatment.
• It is often inflicted in a subtle way, especially if it is pre-meditated and deliberate.

7. Elder abuse can be difficult to identify because some diseases and chronic illnesses can mask or mimic the visible signs of abuse. For instance, some diseases cause people to bruise more easily. Weight loss can be a symptom of a disease, the caregiver's failure to provide meals or an elder who neglects to eat properly.

8. Violence as learned behavior: Violence is a learned behavior that in some families is passed on from one generation to the next. In these families, abusive behavior is their usual response to life because they have not learned other more appropriate ways to respond. If a person was verbally or physically abused by a parent as a child, he or she may repeat that behavior with a bedridden elderly parent.

9. Risk factors that may contribute to elder abuse are: mental illness, alcoholism, drug addiction, financial difficulty, caregiver stress, caregivers who lack proper caregiving skills and ageism.

10. Lack of caregiver skills can lead to unintentional injuries such as bruises and broken bones.

11. Ageism is a form of prejudice against older people based upon negative
images and stereotypes. Ageism increases the risk of elder abuse. The abuser uses these prejudiced attitudes to justify mistreatment of an elder.

12. The legal definition of elder abuse varies from state to state but it is generally agreed that the forms of elder abuse include: physical abuse, sexual
abuse, emotional and psychological abuse, financial exploitation, neglect and abandonment.

13. It's important to learn how to identify various kinds of abuse because the signs and symptoms of elder abuse are often hidden by both the abuser and victim.

14. Neglect is a leading form of elder abuse. Neglect typically means the refusal or failure to provide the necessary care to an elder by someone who has assumed that responsibility. It includes the refusal or failure to provide the elder
with life necessities such as food, water, shelter, clothing, personal hygiene, medicine or personal safety.

15. Some signs and symptoms of neglect include: unsanitary living conditions, fleas, lice, smell of fecal or urine odors, soiled linens, poor hygiene, untreated bedsores, unsafe living conditions or dehydration.

16. Self-neglect occurs when elders who are taking care of themselves do so in a way that jeopardizes health and well-being. Examples include living in an unsanitary home, poor personal hygiene, not eating or drinking enough or eating non-nutritious meals and taking too much or not enough medication.

17. Questions to ask about possible financial exploitation: Who has check writing authority? What about authority for other legal documents? Has there been any sudden changes in bank accounts? Has there been unusual events, such as withdrawal of large sums of money?

18. Financial exploitation can take various forms, including theft of jewelry or money or unauthorized use of ATM cards. Bed or wheelchair bound elders or those with dementia are most at risk. Scams that target seniors also are considered financial exploitation.

19. Emotional/psychological abuse: Harsh speech, making the older person feel as if they are a bother or not important, acting as if their needs don't matter, withholding things elders need such as food or attention are all considered emotional/psychological abuse. This type of abuse can be as damaging as physical abuse. It drives the person who is being abused into an isolated state.

20. Physical abuse: The use of bodily force that can result in physical pain or injury. Hitting, shaking, kicking, pulling hair, inappropriate use of drugs and physical restraint are all considered physical abuse.

21. Signs and symptoms of physical abuse include: bruising, welts, black eyes, broken bones, rope marks, sprains and open wounds. Look for signs on the back and stomach as these are areas abusers may use to try to hide abuse.

22. Sexual abuse: Includes unwanted sexual contact, sex with someone unable to give consent, sexually degrading acts and forced sex. Elders are often reluctant to speak about sexual abuse.

23. Signs and symptoms of sexual abuse: Upset at being dressed or undressed, torn, stained or bloody underclothes, vaginal or anal bleeding.

24. Abandonment: Deserting an elderly person at a mall, hospital or other location with no intention of returning for them.

25. Take any complaints seriously. It may be difficult for the person to express what is happening. Be open and sensitive. Listen and do not bombard the person with questions.

26. Be aware of sudden changes in behavior, such as when a once talkative person becomes withdrawn and depressed. Notice any fear or agitation.

27. Abusers may use any means possible to deflect attention from the abuse. They may try to prevent home health nurses and others from entering the home.

28. No single characteristic identifies an abuser. Abusers may be charming, humorous and leaders in the community or church.

29. Most victims do not report abuse because of shame, denial, fear and isolation. They may be unable to report abuse because of physical disabilities or dementia.

30. Become aware and educated about elder abuse. Patients should have private time with their health care provider so that they feel safe in confiding any concerns they may have. Providers must do very good screening, being careful and sensitive in the interview process.

31. Many states have mandatory reporting laws for health care professionals who suspect elder abuse. Follow your agency's policy for reporting abuse.

32. Adult Protective Services is the agency that receives reports of abuse. Their professional staff follows through with an investigation.

1. When you provide home care, you naturally learn a great deal about your clients’ lives. That may make the experience more personal, but also brings with it the responsibility to keep client information private.

2. Confidentiality or privacy is very important in health care. All health care providers, including doctors, nurses, home care providers and companions are required to keep client information private.

3. Protecting your client’s privacy is respectful and professional. It is an essential part of your job as a care provider.

4. Privacy rights are legally enforced through HIPAA, a federal law passed by Congress in 1996. HIPAA stands for Health Insurance Portability and Accountability Act.

5. HIPAA’s Privacy Rule defines how health care providers must relate to Protected Health Information or PHI.

6. PHI is health or billing information that identifies or can be used with other information to identify an individual.

7. There are 18 PHI identifiers. They include:
 Patient name
 Any geographic subdivisions smaller than a state such as street address, city, county and zip code
 Dates such as birth date, admission date, discharge date, death date
 Telephone and fax numbers
 Email or website addresses
 Social Security numbers
 Medical record number
 Health plan numbers or account numbers
 Certificate or license numbers, vehicle ID numbers or license numbers
 Full face photographic images or comparable images
 Finger or voiceprints
 Names of relatives.

8. Minimum Use requirement: HIPAA requires that care providers use only the minimum amount of information needed to give care to their clients. Remember that reading patient or client medical records casually or just to satisfy curiosity is a breach of HIPAA and can lead to reprimand or job loss. Always ask yourself: what is the least amount of information I need to know to do my job. Minimum use also applies to providing information to someone authorized to receive it. Again ask yourself, what is the least amount of information I need to provide to answer the request?

9. Do not discuss your patients or clients with friends, family or other clients. Never disclose your client’s name, location or lifestyle or talk about things that occurred during your shift.

10. Focus your conversation only on the client you are with. Never talk about other clients, their homes or any other details of their lives.

11. Before your first client visit, you should know who is authorized to receive private information regarding your client’s condition or treatment. If you don’t know or if you are unsure, check with your agency before sharing protected health information.

12. If your client wants information withheld from particular people, report the request to your agency’s privacy officer, who will respond. Let your client know that you are not permitted to make decisions about restricting information.

13. Keeping conversations private: When you talk about clients to others who are involved in their care, try to prevent anyone else from overhearing the conversation. Whenever possible, hold conversations about clients in private areas.

14. Never give your personal cell phone or home phone number to clients. Clients must communicate directly with the agency about their needs rather than relying upon you as if you were a personal friend. You may feel very friendly toward your client, but you must remember your role as a professional care provider.

15. You can share medical information about your client or patient:
 at the client or patient’s doctor’s office
 at the pharmacy when picking up your client’s prescriptions
 to a supervisor or co-workers involved in that client’s care
 to 911 or the hospital
 to a relative or friend who has authorization to receive protected health information about your client.

16. Medical records management: In the office, keep client records closed after use, never leave any PHI on desks or open areas. This includes notes, labels or forms with patient names. When records are not in use, they should be stored in a locked cabinet or locked room.

17. Proper disposal of PHI: Private health information such as copies of medical records or billing records must be shredded or incinerated if it is no longer in use or needs to be destroyed. Any paper with PHI on it such as post it notes or scrap paper should be shredded as well.

18. Care Plans: If you are seeing several clients in one day, take only the care plan or assignment sheet of the client you are visiting into the home, and leave the other records locked in your car out of sight. During your home visit, be careful not to leave private health information out where family members or others may see it. Any medical record should be kept in your line of sight during the visit. That means close to you so that you can see it at all times.

19. Documenting PHI communicated by telephone: When you give PHI to a caller authorized to receive it, document it in your notes, giving the name of the caller, the date of the call and a brief description of the request and information shared.

20. Computer security: When you are at the office, make sure that your computer monitor is turned away from public view to protect client information. Using a privacy filter on your monitor will decrease its visibility to others. Only 10% of computer security is technical; 90% relies upon the person who is using the computer. In other words, you are the most important part of keeping electronic information secure.

21. Password protection is essential to computer security. Never share your computer password. Memorize your password, never keep a paper record.

22. Laptops and Personal Digital Assistants: When using a lap top computer, keep it with you at all times or lock it safely in the car out of sight. One way to secure your PDA is to carry it on your body in a belly
pack. When not in use, lock your PDA in your car out of sight just as you would lock any protected health information.

23. Faxes: When faxing send only the minimum PHI needed and avoid sending sensitive health information such as information regarding HIV or sexually transmitted diseases. Verify the fax number before sending it.
Always use a fax cover sheet that includes a confidentiality statement. Do not include any PHI on the fax cover sheet.
Take reasonable precautions to ensure that the intended recipient is either available to receive the fax as it arrives or has exclusive access to the fax machine. Retrieve documents from the fax machine promptly.

24. Answering machines: Do not leave messages regarding private health information on an answering machine unless the client or patient has given you permission.

25. HIPAA Penalties: HIPAA violations can result in disciplinary action or termination from employment. In addition to employee penalties, you can be subject to civil or criminal charges by the government. Fines or prison sentences can result from the following:
 Knowingly releasing patient or client information to someone who is not authorized to receive it
 Gaining access to health information under false pretenses
 Releasing patient or client information with harmful intent
 Selling patient or client information


HIPAA for Caregivers
Update

Since HIPAA was enacted over 15 years ago, the way information is stored and shared has changed. Rules and regulations must change with the times to ensure they are still relevant; in other words, as our world changes, so must our laws with it.
Over the last 15-20 years, technology has become more dominant in several ways:
• The way we communicate
• The way we share information
• The way we store information
But technology isn’t the only way information is shared. There are different ways sensitive information can be shared:
• Electronic
• Spoken
• Printed
Sensitive information includes
• Health information that is individually identifiable
• Passwords for computers
• Social security numbers
• Credit card numbers
• Driver’s license numbers
• Personnel information
• Research data
• Computer passwords
• And more – what can you think of that is considered sensitive information that should be protected?

Overview
It is the policy of Advantage In-Home Services, LLC, Advantage Consumer Directed Services and its affiliates (collectively referred to as the “Advantage”) to comply with all applicable federal and state laws regarding fraud, waste and abuse. Advantage acknowledges its participation as a Government Programs contractor in federal and state sponsored health care programs, including Medicaid. As a Government Programs Contractor, Advantage is subject to specific state and federal regulatory requirements related to these programs. To comply with Section 6032 of the Deficit Reduction Act of 2005, Advantage provides this policy, which includes information about its policies and procedures and the role of certain federal and state laws in preventing and detecting fraud, waste and abuse in government-sponsored health care programs. This policy applies to all employees, contractors and agents of Advantage.

Administrative Guidelines
I. Procedures for Detecting and Preventing Fraud, Waste and Abuse
Advantage maintains a Corporate Compliance Program that includes activities for the detection, prevention and investigation of fraud, waste and abuse. Advantage
is charged with maintaining a program to detect, investigate, prevent, and recover the loss of corporate, government and customer assets resulting from fraudulent and abusive actions committed by providers, members, subcontractors and employees. To notify Advantage of potential fraud and abuse issues or compliance concerns call its toll free number, 866-568-1192. Advantage acts on referrals received from internal and external sources of potential fraud and/or abuse. Additionally, the company uses other methods to identify potentially fraudulent activity such as claim data extracts.

A. Federal Laws Governing Fraud, Waste and Abuse (FWA)

i. False Claims Act; 31 U.S.C. §§ 3729 – 3733
The federal False Claims Act imposes liability on any person or entity who:
* Knowingly files a false or fraudulent claim for payments to Medicare, Medicaid, or other federally funded health care programs;
* Knowingly uses a false record or statement to obtain payment on a false or fraudulent claim from Medicare, Medicaid or other federally funded health care programs; or
* Conspires to defraud Medicare, Medicaid or other federally funded health care programs by attempting to have a false or fraudulent claim paid.
* Knowingly avoids or decreases an obligation to pay or transmit money or property to the government.

“Knowingly” means:
* Having actual knowledge that the information on the claim is false;
* Acting in deliberate ignorance of whether the claim is true or false; or
* Acting in reckless disregard of whether the claim is true or false.

A person or entity found liable under the False Claims Act is, generally, subject to civil money penalties of between $5,000 and $10,000 per claim, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990, and three times the amount of damages that the government sustained because of the illegal act.

Under the False Claims Act individuals with knowledge of potential violations may file suit on behalf of the government in federal court. These individuals may be entitled to a percentage of the amount recovered by the government. The False Claims Act also provides protection from retaliation and discrimination for individuals that engage in lawful acts done in furtherance of an action under the False Claims Act or in an effort to stop a violation of the False Claims Act.

ii. Program Fraud Civil Remedies Act; 31 U.S. C. §§ 3801- 3812
The Program Fraud and Civil Remedies Act (“PFCRA”) creates administrative remedies for making false claims and false statements. These penalties are separate from and in addition to any liability that may be imposed under the False Claims Act.

The PFCRA imposes liability on individuals or entities that file a claim that they know or
have reason to know:
* Is false, fictitious, or fraudulent;
* Includes or is supported by any written statement that contains false, fictitious or fraudulent information;
* Includes or is supported by a written statement that omits a material fact, which causes the statement to be false, fictitious or fraudulent, and the individual or entity submitting the statement has a duty to include the omitted fact; or
* Is for payment for property or services not provided as claimed.

A violation of this section of the PFCRA is punishable by a $5,000 civil penalty for each wrongfully filed claim and an assessment of twice the amount of any unlawful claim that has been paid.

iii. Anti-Kickback Statute
The federal anti-kickback statute prohibits Advantage, its employees, and contractors from offering or paying remuneration in exchange for the referral, recommendation or arrangement of Government Programs business. Under the anti-kickback statute remuneration is considered to be anything of value that is exchanged. Penalties that may be imposed under this statute for violations include criminal penalties, exclusion from participation in government programs and civil monetary penalties.

iv. Stark Laws
The Physician Self-Referral Act or Stark Law prohibits physicians from making referrals
for certain health services that are payable by Medicare or Medicaid to any entity with
which the physicians have a financial relationship. A financial relationship means either
an ownership interest or a compensation arrangement. The purpose of the Stark Law is
to ensure that referrals for services are made in the best interests of the patient.

v. Health Care Fraud (18 U.S.C. § 1347)
It is illegal to knowingly and willfully execute or attempt to execute a scheme to either
defraud a health care benefit program or to obtain money or property from a health care benefit program by means of false pretenses or representations. Penalties can include fines and/or imprisonment.

B. Illinois State Laws Governing Fraud, Waste and Abuse

i. Illinois False Claims Act (740 ILCS 175/1-8)
The Illinois False Claims Act is modeled after the federal False Claims Act. This Act
provides liability for knowingly presenting a false claim or record to the state or local
government or a Medicaid managed care plan for payment or approval. Violators are liable to the State for a civil penalty not less than the minimum amount and not more than the maximum amount allowed for a civil penalty for violation of the Federal False Claims Act, plus 3 times the amount of damages which the State sustains because of the act of the violator. Notwithstanding the foregoing, violators of the Act can be subject to civil penalties of $5,500 to $11,000 per claim as well as three times the amount of damages that the government sustained because of the illegal act for certain civil actions brought by a private person. As with the federal False Claims Act, individuals with knowledge of false claims may bring action on behalf of the state or the local government, are entitled to a percentage of the proceeds collected, and are protected from retaliation and discrimination.

ii. False Statements Relating to the Medicaid Program
Under Illinois state law, it is illegal for a person, firm or corporation to knowingly
obtain or attempt to obtain payment from public funds for social services, including
medical services by:
* knowingly making a false statement or representation:
* deliberately concealing a material fact; or
* a fraudulent scheme.

II. Whistleblower Protections
An individual who brings action under the Illinois False Claims Act is called a Qui tam plaintiff or whistleblower. Federal law prohibits employers from retaliating against employees who file suits on behalf of the government under the Illinois False Claims Act. Illinois law prohibits employers from retaliating against an employee for disclosing or threatening to disclose practices which violate a law and create a danger to public health or safety or which constitutes health care fraud.

C. Missouri State Laws Regarding Fraud, Abuse and Waste

i. Missouri Health Care Payment Fraud and Abuse statutes (Mo. Rev. Stat. §§ 191.900-914)
Missouri law addresses false Medicaid claims. Specifically, Missouri law prohibits:
a. Knowingly presenting a claim for payment that falsely states the health care provided was medically necessary;
b. Knowingly concealing an event affecting initial or continued payments by a medical assistance program for providing care;
c. Knowingly concealing or failing to disclose any information in order to obtain a payment from a medical assistance program to which the health care provider is not entitled or improperly increasing the amount of any such payment to which the health car provider is entitled; or
d. Knowingly making a claim for payment for health care that was provided that has a lesser value than the amount of the claim.

Criminal Penalties range from imprisonment up to seven years, restitution, and civil penalties of $5,000 to $10,000 per violation, plus triple damages measured as three times the amount of damage sustained by MOHealthNet as a result of the false claim activity. Alternatively, Missouri law authorizes the attorney general to initiate civil actions for violations of Missouri’s false claims laws and recover up to two times the amount of payments received by the person as a result of making false statements or false representations, as well as the state’s cost in pursuing the action.

Missouri law prohibits retaliation against an employee who initiates, assists in, or participates in a proceeding or court action under the Missouri Health Care Payment Fraud and Abuse statutes.

The false claims laws described in this policy create a system for preventing and
detecting fraud, waste and abuse in federal and state health care programs by providing
governmental agencies with the appropriate authority and mechanisms to investigate
and punish fraudulent activity. All Advantage employees will be educated about Fraud, Waste and Abuse, including, but not limited to, the foregoing laws and corresponding regulations.

Sources:
http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2058&ChapterID=57
http://www.mmac.mo.gov/

1. Basic Definitions:
• Vendor= Advantage Consumer Directed Services
• Consumer= The Medicaid participant eligible for services. The Consumer is considered your employer.
• Attendant= You, the person who has been selected to be the caregiver/employee.
• Consumer Directed Services= Home care services authorized and paid for by Missouri Medicaid in which the consumer (client) manages/directs their own care and assumes many responsibilities noted below.

2. Consumer Responsibilities:
• Finding and selection of their own attendant
• Offering a job to their own attendant
• Training attendant to perform the tasks authorized on the consumer’s care plan
• Supervising attendant to ensure they are able to meet personal care needs of consumer
• Firing attendant if needed
• Providing supplies needed to complete tasks on care plan
• Communicating at a minimum monthly with Advantage Consumer Directed Services per state regulation.
• Ensuring attendant provides Advantage Consumer Directed Services with the appropriate information in order to be paid for services. The use of Electronic Visit Verification (EVV) is now mandatory per the state and federal governments.
• Ensuring the time submitted by the attendant does not exceed the amount authorized for. Example: Client is authorized for 200 units (50 hours) of services per month- the consumer must ensure that by the end of the month, the attendant does not turn in time over the 200 units (50 hours) authorized.
• Notifying attendant if client is not home to receive services or need to alter schedule
• Receiving care only from attendants registered and screened by the Missouri Family Care Safety Registry and the Office of Inspector General and Employee Disqualification List.
• Promptly notifying the state and /or Advantage Consumer Directed Services within 10 days of any changes in circumstances affecting your CDS plan of care and/or changes in where you live
• Prompt notification to Advantage Consumer Directed Services regarding any problems resulting from the quality of services delivered by your attendant
• Accept or select an attendant without regard to race, color, national origin, sex, age, religion, political beliefs or disability.

3. Vendor Responsibilities:
• Providing assistance in the general orientation of attendants as requested by the consumer
• Payroll and Accounting functions on behalf of the consumer including collecting EVV records for services rendered and verifying their accuracy, paying the attendant, ensuring all taxes are paid and filing claims for Medicaid reimbursement, preparing annual W2s, etc.
• Making contact with each consumer monthly in order to provide ongoing monitoring of services, ensuring the plan of care is sufficient and being followed and other services as needed to live independently
• Processing of consumers’ and/or attendants’ inquiries and problems
• Public information, outreach and education activities to ensure that persons with disabilities are informed of the services available and have maximum opportunity for participation
• Maintain confidentiality of consumer’s records, including eligibility information from DSDS, according to federal and state laws and regulations
• Ensure the consumer has an emergency and/or back up plan
• Monitor utilization of units by the consumer at least monthly
• Providers must maintain a list of eligible attendants
• Ensure that all attendants are screened and employable according to the Family Care Safety Registry (FCSR), the Office of Inspector General (OIG) and the Employee Disqualification List (EDL).
• Ensure the attendant is not the consumer’s spouse
• Notify the attendant of their responsibility to comply with applicable state laws and regulations regarding reports of abuse and neglect.
• Maintaining confidential consumer and attendant files that are available for inspection
• Submission of quarterly and yearly reports to Medicaid Audit and Compliance.
• Advantage Consumer Directed Services will not discriminate regarding employment on the basis of race, color, national origin, age, sex, handicap/disability, and religious beliefs.

4. Attendant Responsibilities:
• Provide personal care tasks to the consumer
• Follow the Care Plan for the consumer
• Provide “hands on” assistance with physical tasks that benefit the consumer (no time is allocated for stand-by assistance like prompting or cueing). No time can be allotted for respite care or time spent waiting for a consumer at a doctor’s office or any other appointment
• Use electronic visit verification to record time in, time out and tasks completed during shift.
• Provide open and accurate communication to Advantage
• Agree to only provide services to the consumer and not the family or anyone else living with the consumer
• Agree to not commit any acts of fraud, waste or abuse.
• Agree that as a mandated reporter, a personal care attendant is required to report all reasonable suspicion or observation of abuse, neglect, exploitation, possible imminent physical harm or bullying that would require protective services, etc. (MO Adult Abuse and Neglect Hotline: 1-800-392-0210)
• Must meet the other initial requirements listed below.

5. Attendant Qualifications:
• Be at least eighteen (18) years of age
• Be able to meet the physical and mental demands required to perform specific tasks required to meet your care plan needs
• Agree to maintain confidentiality
• Be emotionally mature and dependable
• Be able to handle emergency type situations
• Not be the consumer’s spouse
• Be registered with and screened by the Family Care Safety Registry (FCSR), Employee Disqualification List (EDL) and Office of Inspector General (OIG). Advantage Consumer Directed Services will run these background checks to ensure the person you are trying to hire is eligible.

6. Required Background Checks:
• Advantage will run the necessary background checks to ensure a person is eligible to work as an attendant. This includes being screened by the Family Care Safety Registry, Office of Inspector General and Employee Disqualifying List. If an attendant has lived outside of Missouri for the past 5 consecutive years, a nationwide background screening will also be conducted. If there is a finding on one of the background checks, we will determine if the crime is listed on the disqualifying crimes list per the Missouri Medicaid Audit and Compliance: https://mmac.mo.gov/wp-content/uploads/sites/11/2019/06/Disqaulifying-Factors-FCSR.pdf
• If the crime is listed on the disqualifying list, the person will need to apply for a Good Cause Waiver if they have not previously obtained a Good Cause Waiver. They MUST obtain this waiver before they can be hired.
• At times, there may be a finding that is not severe enough to be on the official disqualifying crimes list but could be something that either a consumer or the vendor is not comfortable with. Both the consumer and Advantage Consumer Directed Services (vendor) holds the right to not enter into an employment contract with someone that has such a criminal record.
• Advantage Consumer Directed Services holds the right to run background checks on attendants routinely throughout their active employment status. At any time in their employment, if it is discovered that an attendant has a recent finding that is on the disqualifying list, the consumer and attendant will be notified that services must stop immediately. The attendant cannot resume services until a good cause waiver is obtained. We do hold the right to end or suspend our employment contract with the attendant for any finding discovered that we are uncomfortable with. You will be notified promptly when and if this does need to occur.
• Advantage will complete an I-9 on all attendants and check the E-Verify to ensure they are legally able to work in the United States. You are required to show proof of a photo ID and social security card.

7. Tasks that may be performed during CDS Services: The consumer will have a care plan that has been tailored to meet their individual needs. The care plan is NOT written by Advantage Consumer Directed Services. At a minimum, the tasks on the care plan must be performed. Additional tasks may be performed but the time spent cannot exceed the time authorized on the care plan.
• CDS may include the following tasks:
o Bathing; including shampooing hair
o Dressing/grooming; includes dressing/undressing, combing hair, nail care, oral hygiene and denture care and shaving
o Ostomy/catheter hygiene
o Bowel and Bladder routine
o Assistance with toileting
o Use of transfer devices/assistance with mobility issues/prostheses
o Passive Range of Motion
o Manual assistance with medications (prompting while assisting, opening mediplanner, handing a glass of water, steadying the glass of water)
o Turning and positioning
o Treatments
o Cleaning and maintenance of equipment
o Clean bath
o Make Bed
o Change linens
o Clean floors
o Tidy and dust
o Laundry (home or off-site)
o Trash
o Read/write essential correspondence
o Meal prep and/or assistance with eating
o Wash dishes
o Clean Kitchen
o Essential transportation- Essential shopping/errands, school or employment. (See transportation questions manual for further details. )

8. Services that are NOT included as a part of the CDS program:
• Tasks that would primarily benefit people other than the client (others that reside in the home)
• Tasks that others living in the household may reasonably be expected to do or share, unless the task is above and beyond typical activities that would be provided for a household member without a disability.
• No time can be provided for stand by assistance, prompting or cueing.
• No time can be provided for respite care or time spent waiting for you at a Doctor’s visit or other appointment
• Tasks that must be performed by a licensed professional (example: nurse, doctor, therapies, etc)

9. Care Plan Training
• Missouri Medicaid has made a Care Plan that has been tailored to meet the individual needs of your consumer. It is crucial that this care plan is always followed. If changes need to be made, your consumer should call the state.
• The Care Plan consists of:
o Start date and end date
o The vendor agency chosen to provide services
o The monthly units authorized for (In order to determine how many hours this equates to follow the formula:
i. Total units – transportation units= Units of personal care
ii. Units of personal care / 4 = Total hours of personal care each month
iii. Transportation units / 4= Total transportation time each month
o Tasks that should be performed by personal care attendant during each shift
iv. You will notice that there is a time frame associated with each task. This is the time that you should spend doing each task. You must ensure that if you work a certain amount of hours, that you also record enough tasks to warrant those hours. Example: The attendant works 2 hrs so they need 2 hours worth of tasks marked for the day. This is extremely important!

10. Scheduling:
• It is the consumer’s decision on what time of day services are rendered. We do ask that you provide Advantage information on when transportation will be provided each week, as the information is needed for our EVV system.
• Remember, you have a care plan to follow so the schedule needs to be at a time of day that allows the care plan tasks to be done. For example, if the consumer goes to bed at 9pm then it does not make sense for you to come at 10pm.
• It is generally best if the consumer determines ahead of time, what their typical schedule will look like each month. This helps you follow the care plan and also helps to ensure all hours are used but that you don’t go over at the end of the month.

11. Electronic Visit Verification (EVV):
• EVV is short for Electronic Visit Verification which is a timekeeping system that requires you to electronically verify you are present and working by means of calling from the consumer’s land line or using a smart phone based app. It is required by Federal and State law for all Medicaid funded personal care services. EVV eliminates the need for paper timesheets and allows the attendant to provide the same information, just in electronic format at the exact time the services are being rendered instead of turning in timesheets days later.
• In order to get paid for your time working, you must submit clear and accurate information to Advantage that proves you did provide services to your consumer.
• The information that must be recorded is your consumers name, your name, the tasks that were performed, date, clock in time, clock out time and location of where service delivery begins and ends (GPS).
• Rules for EVV: Your goal as a CDS attendant is to successfully use the EVV system 100% of the time without the need for manual edits of your electronic records.
o If you have any problem at all using EVV, it is your responsibility to promptly call Advantage’s EVV Call Center to get assistance.
o You must use EVV at the start and end of every shift in the consumer’s home with the consumer present.
o Effective 3/27/22 all visits that require a daily correction form / paper timesheet will have their pay rate (for that specific shift) reduced to the branch base pay rate.
o Effective 3/27/22 all shifts that come through the EVV system cleanly (no correction form needed) will be paid a special “EVV Incentive” rate.
o If the shift information is not complete or accurate in the EVV system, you are required to submit a signed Daily EVV Correction Form to the office to verify the details of your shift. This must be submitted within 48 hours of the worked shift. If this is not submitted in time, your pay may be delayed and pushed back to the next payroll period. (We will not accept the weekly timesheet to be used)
o When clocking out, you are required to enter task codes that correspond with the services rendered. It is important that the care plan is being followed and that enough tasks are being performed for the time spent clocked in. For example: If you are clocked in for two hours, you should enter two hours worth of tasks. You cannot clock in for two hours but only enter thirty minutes’ worth of tasks. In this scenario, initially you will only be paid for the time spent providing tasks to your consumer (30 min). If you feel there has been a mistake made and need to submit additional tasks to reach the full clock in time (2 hours), you will have to submit a signed Daily EVV Correction Form listing the additional completed tasks in order to be paid for the full shift. If not completed within 48 hours of the shift, it will be considered late and will be processed during the next payroll cycle.
o We will not contact you regarding missing or incomplete EVV records. YOU are required to call the EVV call center if you have any problems using the electronic system. These calls must be made while you are the home, when the issue occurs. Any changes to an electronic visit will require the completion of a Daily EVV Correction Form which must be submitted to the office within 48 hours of your scheduled shift in order to avoid payroll delays. The Daily EVV Correction form must be completed accurately and must be signed by the client in order for the change to be submitted to payroll. Advantage will not process missing or incomplete payroll records for any reason whatsoever. Failure to submit accurate payroll records could result in delays to when you receive your check.

• Adverse Actions:
o The state of MO is closely monitoring EVV records for every provider. They can view all records in live time and will know when manual changes to electronic records occur. As a result, the manual editing of visits must be kept to an absolute minimum. If you are found to be repeatedly out of compliance with EVV rules and using the Daily EVV Correction Form too often, your direct deposit may be turned off and your pay will be delayed. In extreme cases, Advantage may have to suspend services until all parties agree to be complaint.
o If the Daily Correction Form is not turned into the office within 48 hours of the shift, it will be considered late and will be processed during the next payroll cycle. This means it would be paid out 1 week later than it would if it were on time. Refer to payroll calendar for payroll dates.
o After adequate training has been provided to you, if you are still having to use Daily EVV Correction Forms each and every week, you will be notified that your direct deposit will be turned off & you will have to come into the office to pick up your paycheck. We may also elect to put your paycheck in the mail on your pay date. Your direct deposit will be turned back on once you demonstrate for 2 weeks in a row 100% EVV compliance (i.e you can use the system without the needing a Daily EVV Correction Form).
o In extreme cases, if all parties are still out of compliance and all efforts have been exhausted to help you, Advantage may have to terminate the attendant employee contract.

12. Client/Consumer EVV FOB Policy:
• Regulation:
o State and Federal regulation requires all Medicaid home care recipients to allow the use Electronic Visit Verification (EVV) in their home. EVV can be administered through a smart phone based APP, through a landline telephone in the client’s home or through the use of a validator box that is secured in the client’s home. The validator box is called a FOB. The FOB must be secured in the home so it cannot be easily removed. The FOB must be in a location that is easily accessible to the caregiver to use at the start and end of their shift, as they are required to use it to clock in and out.

• Responsibilities:
o In situations that require the use of a FOB, Advantage Home Care will provide the FOB to the client along with examples of how to secure it in their home. It is the responsibility of the client to ensure that the FOB is secured in the home and that it stays in the home at all times. If at any time, the client discovers that the FOB is missing, it is the client’s responsibility to notify the office immediately. Upon termination of services, we ask that the FOB be returned to the office
o Employee/Attendant Responsibility: If it has been decided that you are required to use a FOB in order to clock in and out, it is your responsibility to notify the office if you see that the policy requirements are not being followed by the client. In no circumstances are you allowed to remove the FOB from the client’s home unless the branch office has instructed you to retrieve the FOB and bring it back to the office. If it is discovered that you have tampered with or used the FOB outside of the client’s home in order to clock in and out; you could face termination of your attendant employment contract and be hotlined to the Medicaid Fraud Unit.

13. Post Merger Integration Strategy:
• Advantage Home Care acquires many attendants by means of acquisition. Advantage Home Care will initiate a Post Merger Integration Strategy (PMIS). This will grant the new attendant a short grace period after the sale to allow them time to comprehend and transition to following Advantage policies and procedures. During this transition time, it is the mission of Advantage Home Care to provide the field employee with feedback, re-education, extra training and guidance in order for them to find success in their role as Attendant before all policies and procedures are strictly enforced. Please note, this grace period does NOT mean that we can allow for unethical, fraudulent, or dangerous behavior. There is no grace period for actions or behaviors that fall under those categories. The grace period is directly related to payroll functions and procedures.

14. Payroll Process and schedule:
• Each payroll week is Sunday through Saturday
• Upon hire, CDS attendants will be provided with a pay schedule that clearly outlines when each week will get paid out. At the start of the new year, it is the attendant’s responsibility to call the office and ask for a new payroll schedule.
• Advantage only authorizes attendants to submit time up to the total hours authorized on the consumer’s care plan. For example: if the care plan allows for 80 hrs per month, the attendant can only submit and be paid for 80 hours. Any additional hours submitted that exceed the total authorized hours on the care plan are not authorized and will not be paid.


15. Fraud of the Program: Below is a list of situations or circumstances that would be considered fraud and should be avoided.
• Your consumer must be present in order to receive services. Example: Your consumer cannot be at the movies or visiting with a neighbor while you are clocked in at their home.
• Your consumer cannot be receiving care at a facility or hospital during CDS hours. Example: They are admitted to the hospital for 2 days but you go to their house each day to walk the dog and tidy up. Or, you come to the hospital to visit each day and decide to clock in while you are visiting because you help while you are there. Both of these situations would be considered fraud. Services can start back up once your consumer is discharged and back at their home.
• Your consumer cannot clock you in and out because you cannot make it one day. Example: you are out sick on Tuesday but you really need the money so you have your consumer clock you in and out even though you did not work. This would be considered fraud.
• You cannot have your consumer clock you out later if you have to leave early. This would be considered fraud.
• You cannot submit fraudulent time for services not delivered. Example: You are submitting time for working but have not been actually providing you any services. If your consumer makes a suggestion like this, you should not turn a blind eye to this behavior or you are also committing a crime. Always call Advantage or the Missouri Fraud Hotline: 573-751-3285

16. Consumer Rights:
• Receive services without regard to race, color, national origin, sex, age, religion, political beliefs, or disability.
• To be treated with respect and dignity
• Have all personal and medical information kept confidential
• Have direction over services provided as long as care plan is being followed.
• Know the providers established grievance procedure and how to make a complaint about the service and receive cooperation to reach a resolution without fear of retribution
• Hearing Rights: (per 19 CSR 15-8.500 Hearing Rights)
o When a consumer is determined ineligible for consumer-directed services (CDS) or when a dispute arises concerning the provision of CDS, after the preparation of the CDS plan (plan of care), or termination of CDS, the consumer may request in writing a hearing with the Dept of Social Services (DSS).
o A consumer may request a hearing by contacting Department of Health and Senior Services (DHSS) in writing within 90 days of denial or eligibility, denial of financial assistance, the determination of financial assistance, discontinuation, suspension or reduction of CDS.
o If the consumer appeals in writing within 10 days of the mailing of the notice regarding denial, suspension, reduction or termination of CDS, DHSS will not suspend, reduce or terminate services provided to a consumer under an existing plan of care pending a decision from a hearing, unless the consumer requests in writing that services be suspended, reduced or terminated.

17. Consumers are not allowed to:
• Threaten or abuse or allow other members of your household (or guests) to threaten or abuse provider staff. This will result in your services being terminated
• Expect care to be provided to your pets, friends or visitors. This is not allowed under the CDS program.
• Allow services to be provided in your home when you are not home.
• Engage in activities that would be considered fraud of the program, for example: submitting time for payment for services that were not actually provided. This could result in your services being terminated.

18. Essential Transportation
• Some CDS consumers will be authorized essential transportation on their Care Plans. This includes all essential shopping/errands (whether or not the participant is with the CDS attendant), school and employment. For the participant to be eligible for transportation assistance there must also be an identified need for personal care assistance, even if that need is met by supports other than CDS.
• CDS Transportation does NOT include transporting to medical appointments when that appointment is covered under the NON-Emergency Medical Transportation (NEMT) program. To determine if the medical appointment is covered by NEMT, contact the NEMT provider at 1-866-269-5927.
• There are many questions that arise when determining if a situation would be authorized under Essential Transportation. Please feel free to ask a vendor representative or refer to the Policy Clarification Questions and Answers located at: https://health.mo.gov/seniors/hcbs/pdf/pcq.pdf.

19. Signatures:
• There may be times that a consumer and/or attendant signature is required to verify information. When this occurs, we ask that only full names be used. We prefer no initials of any kind be used in order to validate the person’s identity. (Because of physical restrictions, if the consumer is physically unable to sign their full name, we do allow the consumer to make their “mark” but another responsible person in the home must sign their name (not the consumer’s name) after the mark as the witness. If no consumer “mark” can be made, the responsible person/witness can sign their name as long as the consumer is present to authorize the signature.)

20. Liability for injuries, illness and damage
• The attendant is the employee of the consumer and is never considered an employee of the vendor, Advantage Consumer Directed Services. With that being said, Advantage Consumer Directed Services is not liable for any illness or injuries sustained by the attendant or consumer. Advantage Consumer Directed Services also has no liability towards damages done to possessions of the attendant or consumer.

21. Abuse & Neglect/Exploitation/Misappropriation/Falsification of Services
• Advantage Consumer Directed Services strictly prohibits abuse or neglect towards consumers.
• All attendants will be trained upon hire by Advantage Consumer Directed Services to recognize abuse and neglect. As an attendant, you are considered a mandated reporter and must report to the department and/or the vendor immediately any alleged or suspected abuse of a consumer. Failure to report the suspected abuse or neglect could result in termination of employment contract, criminal prosecution, or both.
• The 5 definitions of abuse and neglect are: Neglect, Misuse of Funds / Property, Physical Abuse, Sexual Abuse and Verbal Abuse.
• Procedure for Identification and Reporting:
o Any attendant who has cause to believe that a consumer has been subjected to abuse, neglect or any fraudulent activity should report it immediately to the vendor and the Elder Abuse Hotline (1-800-392-0210) or MMAC Fraud Hotline (573-751-3285)/mmac.reportfraud@dss.mo.gov or to the Child/Abuse Hotline (1-800-392-3738).
o All reports are confidential.
• It is the policy of the Vendor to take the appropriate steps to prevent the occurrence of abuse, neglect, exploitation and misappropriation of Consumer funds, including falsification of service delivery documents. The Vendor will ensure that all alleged violations of any of the before mentioned are reported immediately to the Elder Abuse Hotline (1-800-392-0210) or MMAC Fraud Hotline (573-751-3285)/mmac.reportfraud@dss.mo.gov or to the Child/Abuse Hotline (1-800-392-3738).
• As stated in a previous section, EVV records need to be a true and accurate representation of the services that were rendered. Those records become a part of the billing process, part of the consumer chart and a legal document. Any falsification of records will not be tolerated by the Vendor and will be hot lined immediately.
• Please refer to the additional Abuse and Neglect training as well as the False Claims Act training provided to you as a part of your Attendant Orientation.

22. HIPAA and Client Confidentiality Policy:
• It is the policy of Advantage Consumer Directed Services and expected that all consumer medical information is kept strictly confidential. This means that consumer identifying information is not shared with anyone, including family members. This includes consumer care plan information and any other documents provided regarding the consumer. Care Plans and other forms provided to attendants from Advantage Consumer Directed Services should be kept in a private and secure location.
• Any breech in this policy is subject to termination of the employee contract by the vendor and possible legal actions for violations of applicable regulations and laws.
• Refer to additional HIPAA training manual provided to you during your Attendant Orientation for more information.

23. Drug Free Workplace:
• It is expected that all parties maintain a drug free environment in which services are to be delivered. Services can be suspended or terminated by any party if another member should be in breach of this policy.

24. Consumer Emergency and Backup Plan:
• Each Consumer is required to have an emergency and backup plan in case of emergencies. It is your responsibility to make yourself familiar with this plan.

25. Preparing for Emergencies:
As an attendant you are required to be able to handle emergency type situations. When there is a medical emergency it is recommended that you call 911 immediately. There are ways to prepare for common emergencies prior to them happening. Many resources can be found on the DHSS website here: https://health.mo.gov/emergencies/readyin3/

26. Vendor Text/Email Notifications
• Advantage Consumer Directed Services may send out text/e-mail notifications to consumers or attendants to pass on information. If you wish to not receive any updates from the agency via text or e-mail, you have the ability to opt out/unsubscribe at any time.

27. Employee Reference Requests:
• As a vendor for the MO Medicaid CDS program, we are not required to check employment references upon hire for attendants. However, if a consumer would prefer that references are obtained we would be happy to either pass on the information to the consumer so they can call on the reference or we can obtain the reference ourselves upon Consumer request.

28. Vendor Oversight:
• The Attendant and Consumer must keep open communication with the VENDOR regarding scheduled hours and when services are not able to be delivered. The VENDOR will also conduct mandatory monthly telephone check in calls as well as an annual face to face visit in order to monitor services being delivered.

29. Grievance Policy and Procedures:
• It is the policy of this Vendor to provide all attendants and those seeking services with a copy of the Grievance Policy and an opportunity to file a grievance. If you choose to file a grievance, be assured that no adverse repercussions will occur to you in any future interaction with this vendor.
• You can file a grievance in three ways. You will receive a response in a timely manner.
o Call the Your Voice Matters Reporting Hotline: 314-530-7979.
o Email: reporting@advantagehomecare.com
o Writing a letter to the Director of Advantage Home Care at 11796 Westline Industrial Dr. St. Louis, MO 63146
30. Vendor Mission and Values
• Mission Statement: We help people remain safe, healthy and independent in the comfort of their own homes by expanding our customers access to choice.
• Vision Statement: Advantage’s culture is driven by exceptionalism, integrity & innovation. We are obsessed with providing exceptional customer service & promote transparency, and collaboration in all that we do. We pride ourselves on communication & measure success by the value we create in the communities we serve.
• Core Values:
o Customer Service: Provide fanatical customer services in all that we do.
o Integrity: Always do the right thing, even when no one is looking.
o Respect: Always treat clients, employees, coworkers & referral sources with dignity & respect.
o Innovation: Promote a culture of innovation and continuous improvement throughout our organization.
o Culture: Foster a family friendly culture that others want to be a part of by being professional, happy and fun.
o Exceptionalism: Show our passion for what we do by always striving to be the best that we can be.
o Communication: Promote open, honest, clear and concise communication at all times
o Community: Remain active participants in the communities we serve & try to help others anytime we can.

31. COVID-19 Policy
• You can view the agencies full COVID-19 policies and procedures on the website at: https://www.advantagehomecare.com/covid-19/
• We suggest that all attendants should cease providing services to their client if they are experiencing any symptoms related to a communicable disease including the novel coronavirus.
• We suggest that an attendant should contact the office upon onset of symptoms to make us aware so we can take appropriate action.
• During the coronavirus pandemic, it is suggested that all attendants ask their consumer a series of questions prior to the start of their shift. If the consumer answers “yes” to any other questions (besides the question relating to social distancing), we suggest they cancel their shift and contact the office immediately for guidance.
• Below is a list of the questions. PRIOR to making direct contact with the consumer, attendants should identify consumers at risk for having COVID-19 infection (This can be done over the phone before arrival or upon arrival but while maintaining 6ft of distance from the client). They should ask the consumer the following questions before providing any type of services:
o Have you traveled within the USA or internationally in the last 14 days?
o Have you had signs of a respiratory infection in the last 14 days such as a fever, cough and/or sore throat?
o Has anyone you live with had signs of a respiratory infection in the last 14 days such as a fever, cough and/or sore throat?
o Have you had contact with anyone who has been diagnosed with, or screened for COVID- 19?
o Are you practicing social distancing including staying at home and not allowing visitors?


Attendant Acknowledgement of Training and Vendor Policies Agreement

The Following Topics were reviewed during attendant orientation and training:
1. Basic Definitions
2. Consumer Responsibilities
3. Vendor Responsibilities
4. Attendant Responsibilities
5. Attendant Qualifications
6. Required Background Checks
7. Tasks that can be performed
8. Services that are not included with CDS
9. Care Plan training
10. Scheduling
11. Electronic Visit Verification (EVV) Policy and Rules
12. Client/Consumer EVV FOB Policy
13. Post Merger Integration Strategy
14. Payroll Process, schedule and paycheck information
15. Fraud of the Program including examples of fraud
16. Consumer Rights
17. Consumer prohibited activities
18. Essential Transportation
19. Signatures
20. Liability for injuries, illness and damages
21. Abuse, Neglect, Exploitation, Misappropriation and Falsification of Services
22. HIPAA and Confidentiality Policy
23. Drug Free workplace expectations
24. Consumer Emergency and Backup Plan
25. Preparing for Emergencies
26. Vendor text and email notifications
27. Employee Reference requests
28. Vendor oversight including monthly calls and annual face to face visits
29. Grievance Policy and Procedures
30. Vendor Mission and values
31. COVID-19 Policy
32. False Claims Act
33. Agency Contact Information

In the instance of a confirmed local, statewide, regional, national or world wide pandemic, the agency will establish a specific policy tailored to meet the concerns surrounding the pandemic at hand IF the general communicable disease policy is not sufficient in limiting transmission amongst employees and participants. i.e COVID-19 Pandemic Policy. All pandemic policies shall follow guidance from the CDC and local health departments, state and federal rules and regulations as applicable.

In the instance that a pandemic shall interfere with the regular course of business operations, the agency will follow the following protocol:
1. Communication: All phone lines will remain intact and will be answered as close to normal business hours as possible. After hours on call services will remain available. Communication from the agency to participants and employees regarding the pandemic may come via telephone, text message, email or through our website at www.advantagehomecare.com
2. Office hours: Office hours at branch office locations may be affected due to constraints on employee staffing. Prolonged changes in office hours will be communicated appropriately to applicable parties. Agency staff will remain available via telephone during temporary office closures.
3. Employee Staffing Constraints: In the instance the pandemic results in employee staffing constraints and interruptions to service delivery becomes unavoidable, we will urge participants to utilize all applicable back up plans and emergency contacts in order to stay safe and healthy during unstaffed hours. As required by regulation, the agency will remain in contact with Priority 1 participants and communicate with all state agencies and funders sources as required during an interruption of services.

Preparedness
1. At initiation of services, all participants will be asked to complete an Emergency Plan that includes emergency contact information, back up plans, evacuation routes and a list of required medications. This plan shall be housed in the participant file at the office.
2. At the initiation of services, all Missouri participants shall be provided with Ready in 3 Emergency Preparedness information sponsored by the Missouri Department of Health and Senior Services.

It is important to be ready for emergencies. There are many resources from the state that help you and your consumer prepare for an emergency. They can be found here: https://health.mo.gov/emergencies/readyin3/