Continuing Education is perfect for a (1) designated Administrator or Alternate who must comply with TAC §558.260, and (2) a prior administrator or alternate not currently designated but maintaining compliance with TAC §558.260, and (3) anyone who wants to improve their knowledge on a broad range of topics specific to TX HCSSAs.
Continuing Education programs are added throughout the year soon after TAHC&H conferences/events conclude. All programs are à la carte, that is, you have the flexibility to browse and order programs that suit your specific needs and are applicable to your role and responsibility.
[3371] Anatomy of the Cash Crunch; Solutions for Home Health Challenges with PDGM – Part 1
Gain insight on the vital parts and pieces to improve
performance with the new payment requirements.
TAHC&H CONFERENCE RECORDING: This program was presented on 2/13/2020 at the Texas Association of Home Care & Hospice Winter
Conference in Denton. It is one of 18 presentations captured and produced for online access. Subscribers receive 24/7 on-demand access from both home
and office during the subscription period shown at the bottom of this page.
Presentation Info:
Presentation Date: February 13, 2020
TAHC&H Event: TAHC&H Winter Conference | Denton
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.5 Clock Hr(s)
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][6]risk assessment and management
§558.260[a][7]financial management
Program Description: The new cash reality under PDGM has home health agencies eager to determine if their
well-laid plans have created effective change to strengthen clinical and financial operations. Gain insight on the vital parts and pieces to improve
performance with the new payment requirements. From revenue validation to organizational processes, Ron Barrera will diagnose and provide a treatment
plan to manage cash flow and achieve greater efficiency.
TAHC&H Faculty/Presenters: Ron Barrera, Managing Director, Simione Healthcare Consultants LLC
About the Presenters: Ron Barrera serves as a Managing Director at Simione Healthcare Consultants, drawing on more than 30 years of
progressive financial, operational and strategic experience as a home health and hospice executive, consultant and interim leader. He spearheads team consulting efforts in finance
to support clients with financial reporting and analysis, budgeting, accounts receivable management, benchmarking, strategic planning, transition of new acquisitions, purchasing and Medicare/Medicaid reimbursement issues.
A resident of Alpharetta, Georgia, Ron previously served as Vice President and Chief Financial Officer for the Visiting Nurse Association of Texas in Dallas/Fort Worth, and
also served as a vice president of operations for a large for-profit home health agency. In his role as a consultant, he has assisted organizations in achieving enterprise wide goals
for transformation and performance improvement, enhancing back office processes, systematizing end-to-end departments and their deliverables, and developing shared service functions.
As a highly experienced interim leader, Ron has served as executive director and chief financial officer, managing financial, operational and reimbursement functions for providers
ranging in size from $25M to $280M+ in annual revenue. An active member of the National Association for Home Care and Hospice, and the Home Care and Hospice Financial Managers Association,
Ron is a seasoned speaker for state and national associations. He graduated with a B.B.A. in accounting from Lamar University.
[3371] Anatomy of the Cash Crunch; Solutions for Home Health Challenges with PDGM – Part 1
[3372] Anatomy of the Cash Crunch; Solutions for Home Health Challenges with PDGM – Part 2
Insights for teams, team leaders and case managers based on the findings of gap analyses...
TAHC&H CONFERENCE RECORDING: This program was presented on 2/13/2020 at the Texas Association of Home Care & Hospice Winter
Conference in Denton. It is one of 18 presentations captured and produced for online access. Subscribers receive 24/7 on-demand access from both home
and office during the subscription period shown at the bottom of this page.
Presentation Info:
Presentation Date: February 13, 2020
TAHC&H Event: TAHC&H Winter Conference | Denton
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.5 Clock Hr(s)
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][6]risk assessment and management
§558.260[a][7]financial management
Program Description: The new financial realities under PDGM require home health agencies to look closely at
clinical operations and make accommodations that will uphold quality, including care alternatives that add value to the equation. Laura Wilson shares
insights for teams, team leaders and case managers based on the findings of gap analyses to help organizations make a successful transition under the new requirements.
TAHC&H Faculty/Presenters: Laura Wilson, RN, BSN, COS-C, Senior Manager, Operations Consultant, Simione Healthcare Consultants LLC
About the Presenters: Laura Wilson A nurse in home-based care since 1985, Laura has served in progressively
responsible clinical and regional leadership roles in the throughout the United States, including Minnesota, Washington, and Florida. Her extensive expertise includes
multi-site operations, quality management, human resources, compliance, business development in home-based care. With additional experience in home health consulting
and acute care, she has worked to advance the role of home health, hospice and palliative care to support population health with health systems and networks.
Wilson previously worked for Kindred at Home (MN), North Memorial Health Care (MN), Intrepid USA Health Care Services (TX), Nurse On Call Home Health Care (FL),
Tender Loving Care/Staff Builders (Western US), In Home Health (MN), and Health One Home Care & Hospice (now Allina – MN). A certified OASIS clinical specialist,
she earned her BSN from the University of North Dakota, Grand Forks.
[3372] Anatomy of the Cash Crunch; Solutions for Home Health Challenges with PDGM – Part 2
[3296] Applying the State and Federal Emergency Preparedness Rules: What Surveyors Look For in your Policies and Procedures
How to prepare and present evidence of your compliance.
TAHC&H CONFERENCE RECORDING: This program was presented on 10/09/2019 at the Texas Association of Home Care & Hospice Fall
Conference in Grapevine. It is one of 4 presentations captured and produced for online access. Subscribers receive 24/7 on-demand access from both
home and office during the subscription period shown at the bottom of this page.
Presentation Info:
Presentation Date: October 9, 2019
TAHC&H Event: TAHC&H Fall Conference | Grapevine
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
2.0 Clock Hr(s)
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§97.259[d][4]agency responsibilities
§97.259[d][6]emergency preparedness planning and implementation
§97.260[a][3]basic principles of management in a licensed health-related setting
§97.260[a][6]risk assessment and management
Program Description:The next step to understanding the Emergency Preparedness Regulations is to determine how to prepare and present evidence of your compliance.
In this presentation Kay Hollers functions as a surveyor and Jennifer Gibson Osburn functions as an agency administrator. Agencies will be able to learn what to expect from the
surveyor and responses from the agency administrator that satisfy the survey process. They also present strategies agencies can use to be comfortable they have put their best foot forward at survey time.
Special emphasis will be placed on documentation of actions taken in risk assessment, patient classification systems, HIPAA, patient evacuation, and testing of the plan.
Program Learning Outcome: Participants will actively engage in the activity and indicate an intent to change their practice by
ensuring their agency policy and procedures reflect the proper application of the state and federal regulations as they pertain to emergency preparedness to
ensure both compliance and patient safety.
TAHC&H Faculty/Presenters: Jennifer Gibson Osburn, RN, HCS-D, COS-C, Senior Clinical Consultant, Axxess;
Kay Hollers, RN, MPH, COS-C, HCS-D, Independent Consultant, HealthCare ConsultLink
About the Presenter: Jennifer Gibson Osburn is a Registered Nurse with over 23 years of home health industry experience.
She is a certified OASIS and Home Health Coding Specialist, who regularly trains on home health regulation and ICD-10-CM coding. Gibson has held several leadership roles in
home health agencies, including Administrator and Director of Nursing. She consults widely for home health agencies nationwide and is a sought-after contributor to industry
blogs and publications. Gibson is committed to the success of the home care industry and currently serves on several committees for the Texas Association for Home Care & Hospice.
She has a passion for teaching and supporting the home care industry and its dedicated and caring professionals.
About the Presenter: Kay Hollers is well known to TAHCH audiences as she has been an active member or
associate member since her return to Texas in 1985. Kay holds a Bachelor of Science degree from the University of Texas with a major in Nursing and a
Master’s Degree in Public Health from the University of Texas School of Public Health. She also earned a post-master’s Specialist Certification in
Health Care Evaluation from Wayne State University College of Nursing in Detroit. Kay taught Public Health Nursing at Michigan State University and has
practiced in and consulted with home health and hospice agencies large and small, public and private. Kay likes to share her experiences and knowledge
with audiences and has been a frequent presenter for TAHCH conferences and seminars.
[3296] Applying the State and Federal Emergency Preparedness Rules: What Surveyors Look For in your Policies and Procedures
Are You Managing SMART? Know How Your Agency is Doing at All Times
Summary: Learn the
importance of on-going agency performance monitoring and benefits.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
Faculty: Litwin, Sharon
Program Description: During this program the
presenter discusses the importance
of on-going performance monitoring to successful home care agency management. She suggests a variety of clinical,
financial and operational measures that can be put in place to monitor performance and avoid "surprises."
Also outlined are the elements of an agency performance assessment.
Program Objectives: Upon completion of this program, the viewer will be able to:
Discuss how to proactively manage their agency
Complete and evaluate their agency using a Homecare Agency Assessment
Identify key financial, clinical and operational indicators and develop an action plan
Implement action plan and ongoing monitoring of key indicators
About the Presenter:
Sharon Litwin, RN, BSHS, MHA is principal and founder of Missouri-based Five Star Consultants. Sharon has been in healthcare management and administration for 25 years.
For the past 20, she has been actively involved in the homecare industry, from field nurse to Executive Director to Principal Consultant in 5 Star Consultants.
She has worked in and managed certified homecare, hospice, private duty, home infusion and dme as regional and executive directors.
Her expertise is in problem solving, teaching and implementing successful action plans. She is a well known speaker at state and national conferences,
specializing in case management, outcome enhancement, management training, OASIS, PPS, and documentation. She is an expert in regulatory, compliance, and operations.
Education-Training Credits:
1.0 Hr(s) HCSSA Administrator/Alternate
[3846] Are You Running Your Business or is It Running You? [Two Parts]
Learn from the EOS Conference founder along with an insightful panel of your peers.
Presentation Info:
TAHC&H Event | Winter Conference | Fort Worth | Rich-Media Presentation Capture for Your Online On-Demand Access
Presentation Date | February 21, 2024
Presentation Track | Healthcare Leaders C-Suite Education
Program Description: Many organizations and leaders suffer from a lack of alignment and a healthy team. Accountability seems difficult.
Clear directions are misinterpreted. Everyone works harder but doesn’t seem to really be in sync. If this sounds familiar, guess what, you’re normal.
Many leaders and organizations have struggled with these challenges. But they found a path and a solution.
Does your flywheel drive strategic direction, decisions, and priorities?
Are all your “people” issues solved?
Do your employees really care about the business?
Does everyone really fight for the greater good?
If you answered “not really” to any of these questions, you’re not alone. It is time to up your game and your company’s results.
As thousands of business leaders have discovered, the key to continued growth, better outcomes, bigger profits, and fewer frustrations is here: managing your business so it does not manage you.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
2.25 Clock Hr(s)
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
TAHC&H Faculty/Presenter(s): Tom Bouwer, co-author of multiple books and Founder of EOS conference and Pinnacle Guide
TAHC&H Industry Panel Member(s): Dan Willson, PT, MS President & CEO Paradigm Homecare Companies;
Jennifer Prescott, RN, MSN, Founder, Blue Water Homecare and Hospice; Jerre van den Bent, PT Chief Executive Officer, Therapy 2000; Petria McKelvey, Chief Executive Officer, Precision Medical Billing (PMB)
About the Presenter(s): Tom Bouwer is the co-author of What the Heck is EOS?, Profit Works, and Enjoy the Climb.
He is a sought after speaker with extensive experience in helping business leaders get what they want from their organizations. He founded The EOS Conference which now draws over 2,000 attendees a year.
In addition to starting and running his own companies in Turkey, Tom has worked for start-ups and Fortune 50 companies. Tom has consulting experience with Deloitte & Touche and Booz Allen Hamilton.
Today, with The Bouwer Group and Pinnacle, he implements tools companies need to grow and make business easier. He has a B.A. from Hope College and MBA from the Fuqua School of Business at Duke University.
About the Industry Panel Member(s): Dan Wilson Founder and CEO of Paradigm Homecare Companies, spanning West, North, East, and Central Texas.
My focus is on merging healthcare excellence with Christian values in the marketplace. I excel in goal setting, problem-solving, and leading teams to success, dedicating my time to initiatives aligned with my faith.
My mission? To make a positive impact by embodying healthcare excellence and promoting Christian values in business and beyond.
About the Industry Panel Member(s): Jennifer Prescott is the Founder and Chief Operations Officer of Blue Water Homecare and Hospice. She is responsible for the strategic direction,
vision and growth of the fastest-growing senior care agency in Central Texas.
About the Industry Panel Member(s): Jerre van den Bent received his training as a physical therapist in his native Holland. He came to Texas in 1993,
and has worked in pediatric home care since then. Jerre is passionate about the work that he does and is committed to supporting the families of the children he works with. In May of 2001,
Jerre launched THERAPY 2000 out of the basement of his home. Since that time, THERAPY 2000 has become a thriving company providing in-home pediatric services to families across Texas.
About the Industry Panel Member(s): Petria McKelvey Petria’s expertise lies in hands on experience of billing for numerous home health and hospice
agencies throughout the years. She has been in the home health and hospice industry’s for over 21 years and has owned and operated Precision Medical Billing for the past 17 years.
She has supervised, hired, and trained 100s of medical billing staff and speaks regularly at home health association conferences.
[3846] Are You Running Your Business or is It Running You? [Two Parts]
[3659] Are You Turning Challenges into Opportunities? Leading through Chaos and Beyond
Tools to lead with intention, learn how to recruit and retain during a time of scarcity and
motivate your teams during unsteady times.
Presentation Info:
TAHC&H Event | Spring Virtual Conference | Recorded for On-Demand Access
Presentation Date | May 11, 2022
Program Description: The pandemic has been a whirlwind for all leaders as we have had to pivot many times without time to breathe.
Leading teams with less is now the norm. While it is tempting to suggest we are all victims of external forces beyond our control, this is a passive approach that will not
serve our organizations, our clients and our teams. This session will give you tools to lead with intention, learn how to recruit and retain during a time of scarcity and
motivate your teams during unsteady times.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][8]skills for working with clients, families, and other professional service providers
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.25 Clock Hr(s)
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
TAHC&H Faculty/Presenter(s): Jennifer Prescott, RN, MSN, Founder, Blue Water Homecare and Hospice
About the Presenter(s): Jennifer Prescott is the founder of Blue Water Homecare and Hospice and a Registered Nurse.
She is responsible for the strategic direction, vision and growth of the fastest growing independent Home care agency in Central Texas.
As a seasoned professional with over 25 years of experience in nursing and clinical operations, Jennifer is known for compassionate
care for the elderly and maximizing operational excellence. She most recently served as Regional Executive Director at Altus Hospice where she increased sales
300% and tripled the average daily census in 2 1/2 years. Before that, Jennifer was Nurse Manager Operations at Duke University Hospital where she managed the
daily operations of three ambulatory clinics serving 36,000 patients per year. During her tenure, initiatives Jennifer led resulted in a 75% reduction in fall
rates during a six month period. Jennifer began her nursing career learning industry best practices at world class Children's Hospital of Philadelphia.
Jennifer holds a Masters of Science in Nursing from Duke University specializing in Healthcare Leadership and a Bachelor of Science
in Nursing from University of Delaware. Jennifer proudly serves as an Executive Board Member for Capital Area Parkinson’s Society, and VP of Outreach and Education.
She is also on the Executive Board of The Alzheimer's Association Central Texas Chapter. Jennifer is a Certified Dementia Practitioner (CDP). She is based in Austin, TX.
[3659] Are You Turning Challenges into Opportunities? Leading through Chaos and Beyond
[PGM1827] Attracting & Retaining Key Staff: Recruitment & Retention Strategies
Summary: How to
differentiate your homecare and hospice agency, DIY recruitment strategies, team
involvement in recruitment & retention.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][8]skills for working with clients, families, and other professional service providers
Faculty: Smith, Sandra
Program Description: Take control of your recruitment and retention strategies by
creating organizational differentiators and creating an “army” of recruiters. This program guides you in creating a strategic recruitment
and retention plan that will cut out the middle “men” (expensive newspaper ads, boutique websites and major job boards) and help you reap
better results by arming your team with the tools, training and rewards needed to bring needed talent to your homecare and hospice organization.
With the right “walk the talk” behaviors, you can also compel top performers to “stay.”
Program Objectives: Upon completion of this program, the viewer will be able to:
Discuss how and why to embrace agency differentiators
Identify reasons to adopt a "DIY" recruitment strategy
Identify ways to practice good recruitment and retention "hygiene"
Discuss how to use Continuous Performance Improvement to fuel wanted
retention
About the Presenter: Sandra Smith has specialized in virtually every functional
area of human resources management, with a specialty in healthcare, particularly private duty and home health care sectors. Today, as
President and CEO of HRpathways+, Ms. Smith speaks at conferences nationwide on a myriad of human resources topics, from clinical
onboarding to improving organizational communication to helping clients build a culture that is viewed as "Employer of Choice". In all
cases, she develops useful tools and products to help her clients apply what they've learned easily and successfully.
Sandra is Certified as a Senior Professional in Human Resources by the Society for Human Resources Management, and as a
Master Trainer by Development Dimensions International.
Education-Training Credits:
1.0 Hr(s) HCSSA Administrator/Alternate
[PGM1827] Attracting & Retaining Key Staff: Recruitment & Retention Strategies
[3285] Audit-Proofing Your Medicare Documentation
How proper documentation will alleviate the fear of Medicare audits.
TAHC&H CONFERENCE RECORDING: This program was presented on 08/28/2019 at the Texas Association of Home Care & Hospice 50th
Annual Meeting in Grapevine. It is one of 17 presentations captured and produced for online access. Subscribers receive 24/7 on-demand access from
both home and office during the subscription period shown at the bottom of this page.
Presentation Info:
Presentation Date: August 28, 2019
TAHC&H Event: TAHC&H Annual Meeting | Grapevine
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.5 Clock Hr(s)
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§97.259[d][4]agency responsibilities
§97.260[a][3]basic principles of management in a licensed health-related setting
§97.260[a][6]risk assessment and management
§97.260[a][7]financial management
Program Description: Do you fear ADRs and payment reviews? This program covers how proper documentation will alleviate this
fear as you learn strategies to prevent the largest majority of Medicare payment recoupments.
Program Learning Outcome: Participants will actively engage in the learning activity and indicate an
intent to change their practice by implementing best practices in clinical documentation to mitigate Medicare payment recoupments and ensure optimal patient outcomes.
TAHC&H Faculty/Presenter: Jennifer Gibson Osburn, RN, HCS-D, COS-C, Senior Clinical Consultant, Axxess
About the Presenter: Jennifer Gibson Osburn is a Registered Nurse with over 23 years of home health industry experience.
She is a certified OASIS and Home Health Coding Specialist, who regularly trains on home health regulation and ICD-10-CM coding. Gibson has held several leadership roles in
home health agencies, including Administrator and Director of Nursing. She consults widely for home health agencies nationwide and is a sought-after contributor to industry
blogs and publications. Gibson is committed to the success of the home care industry and currently serves on several committees for the Texas Association for Home Care & Hospice.
She has a passion for teaching and supporting the home care industry and its dedicated and caring professionals.
[3285] Audit-Proofing Your Medicare Documentation
[W3646] Avoiding Criminal Liability | Views from a Former Federal Prosecutor
A 2022 TAHC&H Member Webinar - Now Available to All!
Presentation Info:
TAHC&H Virtual Event | 2022 Monthly Member Webinars | Recorded for On-Demand Access
Presentation Date | July 7, 2022
Program Description: John Pierce served as a federal prosecutor in three different U.S. Attorney’s Offices around the country.
He also served on the Attorney General’s Advocacy Committee for Health Care Fraud. After leaving the DOJ, Mr. Pierce has represented a wide variety of health care
providers and suppliers around the country in criminal health care fraud investigations and prosecutions. During this session, Mr. Pierce will discuss the current criminal
risk areas facing home health and hospice agency owners and staff. He will discuss recent prosecutions by the government and cover steps that you can take to reduce
your level of risk. Join John Pierce and moderator Robert Liles as they discuss the current criminal enforcement landscape facing your agency.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][6]risk assessment and management
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.0 Clock Hr(s)
Continuing Education for Nurses
1.0 Contact Hr(s)
This program awards CNE until 07.07.2024
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
Nurse CE Approval Statement
Texas Association for Home Care & Hospice is an approved provider of continuing nursing education by Louisiana State Nurses
Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. LSNA Provider No. 4002151
Requirements for Successful Completion
To receive continuing education credits for this online presentation participant must view the entire online presentation, complete an evaluation, and post-test attestation.
Reporting of Perceived Bias
Bias, as defined by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA/LSNA) is the “tendency or inclination to cause partiality, favoritism, or influence.”
Commercial bias may occur when a CNE activity promotes one or more product(s) (drugs, devices, services, software, hardware, etc.). This definition is not all inclusive and participants may use
their own interpretation in deciding if a presentation is biased. The ANCC COA is interested in the opinions and perceptions of participants at approved CNE activities, especially in the presence
of actual or perceived bias in continuing education. Therefore, ANCC invites participants to access their “ANCC Accreditation Feedback Line” to report any noted bias or conflict of interest in the
education activity. The toll free number is 1(866) 262-9730.
TAHC&H Faculty/Presenter(s): Robert W. Liles and John Pierce | Liles Parker Attorneys & Counselors at Law
About the Presenter(s): Robert W. Liles' background is somewhat unique. In addition to a law degree, he holds a Master’s in
Health Care Administration. Robert has worked on the provider side, as a federal prosecutor and now represents home health and hospice agencies around the country in
connection with Medicare and Medicaid audits and investigations. While working as a federal prosecutor, he was asked to serve as the first National Health Care Fraud
Coordinator for the DOJ’s, Executive Office for U.S. Attorneys. In this capacity, he advised prosecutors around the country regarding health care fraud statutes,
schemes, investigative tools, privacy concerns, and compliance issues. Robert is a nationally-recognized speaker and educator on health law regulatory issues.
He has taught and lectured at regional and national conferences, seminars and webinars to federal and state prosecutors, auditors, industry representatives,
providers and suppliers on a variety of regulatory issues.
About the Presenter(s): John Pierce is an experienced former Federal prosecutor and trial attorney whose practice focuses on
sophisticated criminal defense and civil litigation. His background is rather unique. Prior to entering private practice, Mr. Pierce served as an Assistant U.S. Attorney
in the Southern District of California, the District of Columbia and in the Eastern District of Virginia. While working as a Federal prosecutor in the Eastern District
of Virginia, he represented the office on the Attorney General’s Advisory Committee (AGAC) for Health Care Fraud. Since leaving the government, Mr. Pierce has
successfully represented both foreign and domestic individuals and corporations in health care, commercial securities, corruption, export control and tax
disputes. He has also handled a number of whistleblower cases.
[W3646] Avoiding Criminal Liability | Views from a Former Federal Prosecutor
[3789] Avoiding Discrimination and Wage Compensation Violations in Home Health Care and Hospice
Review of the specifics of home care and hospice wage compensation issues.
Presentation Info:
TAHC&H Event 54th Annual Meeting | Rich-Media Presentation Capture | Online On-Demand Access
Presentation Date | August 30, 2023
Program Description: Employment law attorney, Terrence B Robinson, reviews the specifics of home care and hospice wage compensation issues.
Viewers will gain an impactful understanding of the following...
Spotting Issues and taking action in matters of Equal Employment Opportunity
Overview of Federal and State Laws
Understanding the Theories of Employment Discrimination and Harassment
Establishing Proper Employee Compensation Methods to Avoid DOL and TWC Audit Issues
How to Determine Properly Exempt Employees under the FLSA
Employees vs. Independent Contractors
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][2]development and interpretation of agency policies
§558.260[a][3]basic principles of management in a licensed health-related setting
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.0 Clock Hr(s)
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
TAHC&H Faculty/Presenter(s): Terrence B. Robinson, Managing Member at the TB Robinson Law Group, PLLC
About the Presenter(s): Terrence Bouvier Robinson is an experienced litigator with more than three decades in the legal practice,
concentrating his practice on the litigation of complex employment matters. He has extensive experience advising and representing individuals and employers in a wide range of
industries. He has particular knowledge with respect to the employment issues within the restaurant, hospitality, and home health care industries. He represents individuals
and employers in discrimination cases; wrongful termination suits; wage and hour, individual, and collective actions; and tort/contract disputes arising out of the employment
relationship. He specifically handles cases arising under Title VII, the ADA, the ADEA, the FLSA, the FMLA, the TCHRA, ERISA, the Sarbanes-Oxley Act, and various other
statutory and common law causes of action, including claims involving trade secrets, non-compete agreements, workers' compensation retaliation, whistle-blower claims,
defamation, assault, and the intentional infliction of emotional distress.
[3789] Avoiding Discrimination and Wage Compensation Violations in Home Health Care and Hospice
[3502] Avoiding Risky Business – A Texas Home Care Compliance Discussion
The latest legal updates in the home care
industry at the national, state, and local levels...
Presentation Info:
TAHC&H Virtual Event | Winter Conference | Recorded for On-Demand Access
Presentation Date | February 9, 2021
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.5 Clock Hr(s)
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][6]risk assessment and management
Program Description: In this presentation Littler Shareholder, Angelo Spinola, provides a high-level overview of the latest legal updates in the home care
industry at the national, state, and local levels. Angelo will advise on best practices to remain in compliance with the rapidly changing
legal landscape and discusses the highly anticipated legal practices that are most likely to result in new lawsuits as we move
through 2021. With a new administration in the White House and the COVID-19 vaccine, we must anticipate new challenges the industry
may face. Angelo provides you with the solid foundation you’ll need for your business to continue to thrive through 2021.
Program Learning Objective(s): Coming Soon
TAHC&H Faculty/Presenter(s): Angelo Spinola, Shareholder, Littler Mendelson, P.C.
About the Presenter(s): Angelo Spinolais a Shareholder with Littler Mendelson P.C., and is a lead attorney for the
Home Care Practice Group. He represents home care employers across the country in various types of actions brought under the Fair Labor Standards Act and various
state wage and hour laws. Appearing on behalf of employers in federal and state courts and administrative tribunals throughout the U.S., Angelo has litigated all
types of discrimination cases, including age, disability, race, national origin, sex, harassment and retaliation. Angelo’s experience also includes helping employers
respond to wage and hour investigations by the Department of Labor and state agency equivalents, conducting wage and hour practices audits, developing compliance
measures that minimize wage and hour exposure, and representing management in grievance arbitration. Additionally, Angelo assists employers with promoting an
issue-free work environment through counseling, training and other preventive strategies. He also conducts training on employment-related issues for management
personnel, lawyers and human resources professionals. Angelo received a J.D. from George Washington University Law School.
[3502] Avoiding Risky Business – A Texas Home Care Compliance Discussion
[3879] Balancing Engagement and Accountability with Employees
An insightful session that blends compassion with
professionalism, offering strategies to elevate your homecare practice.
Presentation Info:
TAHC&H Event | 55th Annual Conference | Rich-Media Presentation Capture | Online On-Demand Access
Presentation Date | September 10, 2024
Program Description: Watch Lauren and Candyce in an insightful session that blends compassion with
professionalism, offering strategies to elevate your homecare practice. They guide you through essential topics like effective onboarding and
expectation-setting, the importance of establishing clear boundaries, and navigating the unique dynamics of different payer sources. You learn how to
balance personal touchpoints with necessary supervision and master the art of gracefully handling terminations. This program provides you with
practical tools to foster trust-based relationships, enhance caregiver engagement, and ultimately improve the quality of care delivered.
HCSSA Topic(s) Addressed:
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][6]risk assessment and management
§558.260[a][7]financial management
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.0 Clock Hr(s)
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
TAHC&H Faculty/Presenter(s): Candyce Slusher, LVN, Owner of SLUSHER Consulting and Lauren Tobey, Chief Impact Officer at Helping Restore Ability
About the Presenter(s): Candyce Slusher, LVN is a geriatric-focused nurse serving seniors since 1995, working in every
post-acute senior care setting, specifically in non-medical home care since 2004. As a Home Care Consultant her primary goal is to help agencies thrive while providing
the highest quality care to seniors in their communities, while educating, empowering and supporting agency owners in all aspects of operations and compliance.
About the Presenter(s): Lauren Tobey has had a passion for non-profit work since early in her college career.
Lauren has provided marketing and programmatic support services in the sectors of education, social services, and now healthcare. After a time living in Colorado and
Virginia, Lauren moved home to Texas and started working in the disability services field and has served as the Director of Development and Marketing and is currently
the Chief Impact Officer at Helping Restore Ability, the largest nonprofit in-home attendant care provider in Texas. Lauren’s work has been recognized in a variety of
publications, formats, and venues. Lauren believes in allowing stories to paint a picture and utilizing the mind’s eye to enhance and promote services. Lauren has a
passion for generational marketing as well as using digital resources to enhance networking relationships.
[3879] Balancing Engagement and Accountability with Employees
[746] Basic Sales Skills: Mktg. & Sales Tactics to Generate Legendary Results
Subscription Type: Individual
Faculty:Ferris
In this introductory program, Mike provides an overview of the skills
necessary to compete and win more referrals. He has designed this program for all types of staff including outside
sales representatives, community and hospital liaisons, program representatives, sales managers, clinical managers
and administrators. This program is appropriate for anyone having direct contact with referral sources and consumers
in the community. Basic skills covered include:
Proper Introductions
Asking for Business
Handling Objections
Problem Resolution
Differentiation
Competitive Analysis
Using Promotional Items
Goal Setting
Mike is the Director of the Marketing, Sales and Customer Service Consulting
Division at Simione Consultants. Long a nationally recognized expert in
Home Care and Hospice Sales, Marketing and Customer Service, his training
programs are the most acclaimed in the country, receiving accolades from
some of the biggest CEOs and Sales managers from California to New York.
He has the unique perspective of having counseled and consulted with many
of the most successful home care and hospice organizations and seen what
works on a national basis.
Education-Training Credits:
2.0 Hr(s) HCSSA Administrator/Alternate
[3156] BE-ing with Those Suffering: What to and Not to Say
Explores why it
is so challenging to be with others’ pain...
TAHC&H CONFERENCE RECORDING: This program was presented on 02/14/2019 at the Texas Association of Home Care & Hospice Winter
Policy Conference in Austin. It is one of 9 presentations captured and produced for online access. Subscribers receive 24/7 on-demand access from both
home and office during the subscription period shown at the bottom of this page.
Presentation Info:
Presentation Date: February 14, 2019
TAHC&H Event: TAHC&H Winter Policy Conference | Austin
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.5 Clock Hrs
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][8]skills for working with clients, families, and other professional service providers
Program Description: We WANT to be present with others when they are hurting.
We WANT to know what to say or do to help. We’ve simply forgotten that we already know how. This program explores why it
is so challenging to be with others’ pain, what to say, what not to say, and how to care well for ourselves in the process.
Program Learning Outcome:
Participants will actively engage in the activity and indicate an intent to change or enhance their practice by analyzing and
applying appropriate boundaries when caring for those suffering in order to provide presence and healing for the patient and
family while also caring for themselves as caregivers.
TAHC&H Faculty/Presenter: Dr. Carla Cheatham, Founder, Carla Cheatham Consulting Group
About the Presenter: Reverend Dr. Carla Cheatham began in social services with an MA in Psychology,
certification in trauma therapy, a PhD in Health & Kinesiology, and M.Div. before working 10 years as a hospice chaplain and bereavement coordinator.
Carla is a national keynote speaker and consultant focusing on emotionally competent and resilient professionals and organizations, Section Leader
for NHPCO’s Spiritual Caregivers Section, Chair of NHPCOs Ethics Advisory Council, Adjunct Professor at Seminary of the Southwest, and Affiliate
Assistant Professor for University of Maryland’s MS in Palliative Care. She publishes books about grief, resilience, the art of presence, and
emotional competencies for professionals.
[3156] BE-ing with Those Suffering: What to and Not to Say
[2958] Best Business Practices for Private Pay Agencies
Education-Training Credits:
1.0 Hr(s) HCSSA Administrator/Alternate
Summary: Business success tips for private pay agencies
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][5]quality improvement
§558.260[a][7]financial management
§558.260[a][10]marketing
Faculty:Cargle, Ken; Rine, Jennifer; Franco, Carolyn
Program Description:
Private Pay agencies take pride in focusing on client relationships, avoiding the “cookie cutter”
mentality of home health services. What makes the successful agency tick, and… earn a
profit? A seasoned panel of experts from the world of private pay presents
how they have fine-tuned their business strategies in critical areas including staffing, operations and marketing. Presentation Date: 08.11.2016
Learning Outcome: Upon completion of this program, the viewer will be able to:
Examine business success tips for private pay agencies including strategies for proper staffing, efficient operations and effective marketing.
About the Presenters: Ken Cargle is the Administrator/Owner of Goodcare Health Services in Amarillo, Texas.
Ken has been active in home care for over 20 years and has owned a Medicare Certified agency (1994-2000) and has owned a Private Duty agency since 2000.
He received his Bachelor of Arts and Masters of Divinity from Texas Christian University. Professional activities include serving on the American Cancer
Society Board, Alzheimer’s Association Board, and the South Randall County Hospital Board. Ken is also the current president of the Texas Association for Home Care & Hospice.
Jennifer Rine has been a Registered Nurse since 1989 with wide-ranging clinical experience from medical-surgical oncology, labor and delivery, pediatrics, long term care and rehabilitation, and home infusion nursing. She returned to school and completed her BSN in 2008. As the Director of Nursing and Administrator for BrightStar Care her vision is to develop a reputation for passionate patient-centered care and excellence in the home setting by ensuring patients and their families experience the best possible care from a team that is well-trained and supported.
Carolyn Franco, BBA is the Administrator for Home Health Resources Agency- the private duty sister company to Home Health Resources, a licensed and certified home health agency. (HHR) Carolyn has been an organizational leader in the home health and community setting since 1996 when she began her health care career working for HHR, which was opened by her mother. She has 20 years experience in managing home care operations; having previously served as Chief Financial Officer and Director of Human Resources. Carolyn is deeply committed to using her extensive knowledge and experience to address challenges and barriers associated with recruitment, retention, supervision, and training of our most valuable asset, our caregivers, and to bringing Personal Assistance Services to the forefront of the senior care continuum.
[2958] Best Business Practices for Private Pay Agencies
[3697] Beyond Meals-on-Wheels: Social Workers in Hospice
A review of qualifications for social workers in the hospice setting
as-well-as review of scope of practice.
Presentation Info:
TAHC&H 53rd Annual Meeting | Round Rock | Rich-Media Capture | On-Line, On-Demand Access
Presentation Date | September 1, 2022
Program Description: Are you new to hospice or managing social workers for the first time? Are you unsure what
social workers can do in hospice beyond resource referral? This presentation will review the qualifications for social workers in the hospice setting
as-well-as review scope of practice. During this presentation we will also discuss skills necessary to determine competency and discuss possible
scenarios where social workers can intervene.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][8]skills for working with clients, families, and other professional service providers
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.0 Clock Hr(s)
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
TAHC&H Faculty/Presenter(s): Lisa Meadows, MSW, Manager, Clinical Compliance Education; ACHC
About the Presenter(s): Lisa Meadows has over 25 years of experience in the health care industry; from acute care hospitalization, home healthcare,
to hospice and palliative care. She is currently the Clinical Compliance Educator for Accreditation Commission for Health Care (ACHC) - a nationally-recognized non-profit accreditation
organization that has CMS Deeming Authority for Home Health, Hospice and DMEPOS and am responsible for educating organizations on the ACHC Accreditation process as well as assisting
providers with interpreting the ACHC Standards and Medicare Conditions of Participation.
Lisa also successfully prepared and lead the home health and hospice agency where she was previously employed by through the ACHC Accreditation and Medicare
recertification process. Lisa have also worked as an ACHC Hospice Surveyor, allowing me the opportunity to assist organizations with developing best practices and compliance strategies
and has spoken at national and state conferences, and conduct workshops on the accreditation process as well as other relevant health care topics.
[3697] Beyond Meals-on-Wheels: Social Workers in Hospice
[2009] Bigger and Better Customer Service: Winning and
Keeping Clients in Today's Market
Summary: Understanding
a concierge mentality and implementing a concierge approach to win & keep clients.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][8]skills for working with clients, families, and other professional service providers
§558.260[a][10]marketing
Faculty: Orsini, Merrily
Program Description:
Today’s home care market has competitive and economic challenges that require new tactics and tools to succeed. Providing excellence in
both the quality of the care provided and the way it is delivered necessitates a concierge mentality from initial contact through service
provision. How do you build it into the agency as core values? Learning about a concierge approach is key to having staff understand and
practice customer service in each and every client and employee contact.
Program Objectives: Upon completion of this program, the viewer will be able to:
Identify the concierge approach: what it is and how it looks
Develop a plan to add in a concierge mentality for staff at all levels
Identify any issues and/or barriers to developing this approach to excellence
About the Presenter: Merrily Orsini, Managing Director of Corecubed,
is an expert marketing strategist, multiple award-winning business leader, community activist and serial entrepreneur based
in Louisville, Kentucky. She was a pioneer in the home care industry, creating a geriatric care managed model for non-medical
long term in-home care in 1981. After selling that business in 1996, Ms. Orsini followed her passion for communications and
design and started building Corecubed, a full service internet marketing company specializing in home care.
Education-Training Credits:
1.25Hr(s) HCSSA Administrator/Alternate
[2009] Bigger and Better Customer Service: Winning and
Keeping Clients in Today's Market
[2603] SHOW ME THE MONEY!! Bonafide Ways to Improve Cash Flow and Cash Maintenance
Education-Training Credits:
1.50 Hr(s) HCSSA Administrator/Alternate
Summary: A cash receipt plan to help keep cash in the bank.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][7]financial management
Faculty: Spears, Jan
Program Description: Home care and hospice revenues are becoming more and more
difficult to obtain and nearly impossible to keep in today’s atmosphere of non-traditional Medicare with the scrutiny of government
contractors in post payment reviews. This Program explores several key components of a cash receipts plan that will help the agency improve
its conversion of receivables to real “cash in bank.” Surrounding the agency with a robust and timely billing and collections process, while
incorporating key compliance steps, will assist the agency in maintaining its cash in post payment audits. This program also offers processes that
can be implemented to reduce the risk of denials, overpayments or suspension of payments.
Measuring revenue cycle performance over time will prove the worth of developing a comprehensive revenue management program
into home health or hospice operations. Presentation Date: 8.21.2014
Program Objectives: Upon completion of this program, the viewer will be able to:
Identify three typical threats to revenue cycle performance.
Recall two measures to improve the timely conversion of receivables to cash.
Identify three steps to incorporate clinical triggers into the revenue management plan.
About the Presenter: Jan Spears is Co-owner and Chief Executive Officer of MJS & Associates, LLC.
She has more than 30 years’ experience in the health care field. Ms. Spears has owned and operated a multimillion dollar home health care company as well as consulted
for over 300 homecare providers in 25 states. As a full time consultant for the past 15 years she has successfully merged clinical and financial strategies into
successful operational plans for numerous providers nationwide. She serves as a Medicare coverage expert for health care facilities who are undergoing audits by
federal contractors through all levels of appeals. Jan has also authored several publications including Home Health Agency—Policies and Procedures, “Care Guides
for Home Health Practice under PPS”. She heads a team of more than 25 consultants at MJS & Associates, LLC.
[2603] SHOW ME THE MONEY!! Bonafide Ways to Improve Cash Flow and Cash Maintenance
[2606] Bridging Business and Clinical: Achieving Operational Excellence
Education-Training Credits:
1.50 Hr(s) HCSSA Administrator/Alternate
Summary: Three TAHC&H presidents share their expertise.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][2]development and interpretation of agency policies
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][7]financial management
Faculty: Lee, Lucy & Cargle, Ken & Madison, Dana
Program Description: It’s a simple fact – if business operations can’t
“stay in the black”- you won’t be providing patient care very long. Aligning
staff skills and patients’ needs with operational goals can be a challenge. Where do you begin with strategic planning, annual
goal setting and efficiencies? How do you assess administrative overhead? Business managers must consider a multitude
of factors to achieve operational goals and inspire process improvement. What about fixed costs vs. variable costs;
productivity expectations of clinical staff; controlling overtime costs; benchmarks for cost centers? Don’t be overwhelmed!
Learn from the best…in this program a panel of seasoned veterans of successful home care agencies share their expertise
on how to run “the business.” Learn their secrets including enhancing communications with staff to promote the goal of
shared responsibility for operational success. Presentation Date: 8.21.2014
Program Objectives: Upon completion of this program, the viewer will be able to:
Discuss the relationship between clinical practice and financial realities.
Describe the importance of goal setting to achieve business objectives.
Identify at least two strategies to motivate agency staff to achieve clinical operational
objectives.
About the Presenters: Lucy Lee, RN, MS, CHCE, Founder and President of a rural
Texas home health agency, Lucy has been involved in the home health industry for over 28 years. She has first-hand knowledge of the
practical aspects of home health agency management, having worked in all levels of home health care from contract field nurse
through director of patient care to administrator, and is now responsible for strategic planning and alliances. Lucy has served
on the board of TAHC&H representing certified agencies, and has served as secretary, and as president of the association. She has a
Master’s degree in Healthcare Administration and is a Certified Home/Hospice Care Executive.
About the Presenters: Ken Cargle is the Administrator/Owner of Goodcare
Health Services in Amarillo, Texas. Ken has been active in home care for 19 years and has owned both a Medicare Certified agency and
a Private Duty agency. He received his Bachelor of Arts and Masters of Divinity from Texas Christian University and is an active leader
of the Texas Association for Home Care & Hospice; where he has served as President, the Owner auspice, the Licensed Home Health auspice,
and the Licensed and Certified auspice. He has served and chaired on various TAHC&H committees, subcommittees, councils and task forces,
and actively participates on the TAHC&H Owner’s Forum Networking Group.
About the Presenters: Dana Madison, RN, BSN, MBA is the Administrator/Owner of
Calvert Home Health Care, Ltd in Lubbock. Dana’s health care experience includes working as an RN for 30 years, a hospital administrator for
2 years, a Practice Manager in a physician’s office for 8 years and a home health administrator and owner for 19 years. Dana received her BSN
from Texas Women’s University in Dallas, and an MBA in Health Care Administration from the University of Dallas. Dana served as the President
of the Texas Association for Home Care & Hospice from 2010 – 2012.
[2606] Bridging Business and Clinical: Achieving Operational Excellence
[3465] Budgeting and Cash Flow under PDGM
Year two of PDGM presents many cash flow challenges for home health agencies, especially with
the elimination of the RAP payment.
Presentation Info:
TAHC&H Virtual Event | Administrator Program | Recorded for On-Demand Access
Presentation Date | November 19, 2020
Education-Training Credits:
TX HCSSA Administrator/Alternate Continuing Education
1.25 Clock Hr(s)
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][7]financial management
Program Description: Year two of PDGM presents many cash flow challenges for home health agencies, especially with
the elimination of the RAP payment. It is important for an agency to operate effectively in all areas of the revenue cycle to reduce the cycle time for claims
and avoid cash flow issues. This program covers all the critical roles in the revenue cycle process, and discusses how to avoid cash flow issues as well as
identify Key Performance Indicators that impact financial performance and how to develop a realistic PDGM budget.
Program Learning Objective(s): Participants will actively engage in the learning activity and indicate intent to change
their practice by developing a realistic and dynamic 2021 PDGM budget and Identify key performance indicators (KPIs) that impact financial performance in PDGM.
TAHC&H Faculty/Presenter(s): Michael Simione, Manager, Simione Healthcare Consultants | Kim Chapman, Senior Manager, Finance & Revenue Cycle, Simione Healthcare Consultants, LLC
About the Presenter(s): Michael Simione is a Manager with Simione Healthcare Consultants and has been an employee
since 2011. Michael has wide-ranging experience in PDGM, finance, budgeting, strategic planning, cost reporting, data analytics and benchmarking.
Kim Chapman joined the Simione team in 2020 to support the financial goals of home care
and hospice clients with her strong background in claims and billing management in provider organizations, and experience as a consultant and interim manager for
revenue cycle management. She previously served more than 15 years in home and community-based care organizations across billing, EMR/technology analysis, claims
analytics and quality/process improvement disciplines. Between 2005-2020, she served as director of revenue cycle management at Gulfside Healthcare Services, and
held progressive roles in billing coordination, RCM, and patient accounts at Chapters Health System, both in Florida. She also has experience as a revenue cycle
systems analyst with Bon Secours in Virginia. Kim is a graduate of Saint Leo University, St. Leo, Florida, with a B.S. in healthcare management.
[3465] Budgeting and Cash Flow under PDGM