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The home health furor: is a Little Rock company reaping a bonanza thanks to a Pocahontas senator?

There's a furor raging that has one of the state's most powerful politicians -- Sen. Nick Wilson of Pocahontas -- on one side and one of its most powerful organizations -- the Arkansas Hospital Association -- on the other.

Wilson's amendment to a 1991 appropriations bill and a former state department head's effort to cash in on that amendment have Arkansas' home health care industry in an uproar.

One man even says the senator has "frightened" him.

The spending bill appropriated federal funds for nursing home aides to be tested, certified and listed on a state registry.

Wilson's amendment extended those requirements to home health care aides effective Jan. 1.

Wilson, a parliamentary expert, gained approval of the amendment, avoiding home health care representatives in the final days of the 1991 legislative session. State records show the veteran senator followed legislative rules, offering the amendment for the Special Language Subcommittee's approval before it came to the Joint Budget Committee on March 12.

The change was folded into a composite amendment to which the committee gave a do-pass recommendation March 19, eight days before the session ended.

The state Department of Human Services' $545,240 contract to test, certify and register both nursing home and home health aides is held by Walt Patterson's Health Care Training Corp. of Arkansas.

Patterson headed DHS until resigning in September 1989 to work in the private sector in Texas. He returned to Arkansas in 1990 and joined the Little Rock company in January 1991.

Patterson complained in December that the recession was keeping HCTC from prospering. That's because nursing home aides weren't leaving their jobs and thus being replaced by workers who would have to be tested.

Some relief might be ahead, Patterson said at the time, because home health aides would come under the testing law Jan. 1.

Patterson says HCTC was an established company when he became its president and that it already had the state contract to test nursing home aides.

According to Kenny Whitlock, director of the Division of Economic and Medical Services of DHS, the decision to broaden HCTC's contract to include home health aides was made after it was determined the training required for nursing home and home health aides was similar.

Patterson's Letter

On Jan. 17, Patterson sent a letter to Arkansas home health providers telling them that aides who were qualified to perform home health duties as of Dec. 31 would be certified automatically if information on them was sent to his company by Feb. 1.

Those not qualified as of Dec. 31, he said, would have to be tested at one of 16 locations across the state in January, February or March.

Each aide to be tested was instructed to arrive at the testing site with $68, two forms of identification, a photo and a letter from a sponsoring agency saying the person had passed the skills portion of the competency test.

Patterson's DHS contract requires him to "develop and implement, with the Department of Health's approval, procedures used for the collection of ... test fees and billing."

But Roger Busfield Jr., president of the Arkansas Hospital Association, said in a Jan. 20 memo to hospital-related home health providers that Patterson's letter went further than it should have gone.

Patterson's "pronouncements are totally without authority," Busfield wrote. "There are no provisions for home health agencies to begin using Mr. Patterson's service."

The memo reached home health providers at the same time Patterson's letter arrived.

The result was confusion statewide.

"I encourage you to follow Dr. Busfield's advice and request that you not submit any information to Mr. Patterson's company until DHS promulgates rules and regulations," Ernestine Smith, president of the Arkansas Association of Home Health Agencies, wrote to her members in a Jan. 29 memo.

Patterson acknowledges he has no authority to set rules and regulations. The former state department head says he was "just trying to live up to my contract."

He claims DHS officials approved his letter before it was mailed.

"A Head Start"

Whitlock says Patterson didn't show the letter to him. But he adds that Patterson was just "trying to get a head start" by determining which aides would be grandfathered into certification.

Busfield sent copies of his memo to numerous officials. And he sent it to one senator, Nick Wilson.

Asked why he mailed the memo to Wilson, Busfield says it was because the senator chaired a September meeting at which home health providers received some concessions. The providers were trying to resolve differences with DHS officials. Patterson attended that meeting.

Busfield says he wants Wilson to realize that agreements reached at the meeting aren't being kept. He says he was shocked to learn on returning to Little Rock from a meeting in Washington that Wilson was furious with him. When Wilson couldn't locate Busfield, the association head claims the senator "unloaded" on two AHA employees, using language neither he nor the staffers are accustomed to hearing.

"And I'm a Marine veteran of World War II," Busfield says.

Busfield quickly sent a letter of apology to Wilson in which he explained that he had assumed the senator would be upset to learn that DHS had not yet promulgated the regulations.

Wilson's reply was to return Busfield's letter with "take me off your damned mailing list" scrawled across the top.

Whitlock says there are no regulations yet because of the need to:

* First determine how similar the training for home health aides and nursing home aides is.

* Reach decisions about whether any home health aides would be grandfathered.

Busfield says he has no idea why Wilson is so angry but that he is "frightened."

Busfield feels his position is being threatened because the senator demanded to know the name and telephone number of the AHA board chairman.

Wilson admits he was "more than very, very angry" with Busfield "because he should have called me. We could have had another meeting instead of him sending out a memo that paints me as a villain. It's easy to paint me as a bad guy."

Wilson says he sponsored the amendment because Patterson told him the federal government was preparing to require testing for home health aides. Patterson told Wilson the state's system should be uniform so people can switch between nursing homes, hospitals and private homes as the job market changes.

The amendment went into the DHS appropriations bill, Wilson says, because that is where the federal funding was included.

September Agreement

According to Busfield, DHS and home health representatives agreed in September that Patterson's company would administer the written/oral part of the test before providers performed the more expensive skills portion of the competency certification. There would be no need to test those who failed the first, less expensive test, the representatives argued.

But Patterson's letter calls for the opposite procedure.

Busfield's memo was not confined to answering Patterson's letter. Busfield also wrote that his organization's legal counsel, Diane Mackey of Little Rock, has an understanding with DHS chief counsel Debby Nye that there will be no enforcement of regulations on home health aides until the regulations are properly promulgated.

In addition, he said Mackey and an attorney for the non-hospital home health agencies are "to have input into the regulations before they are promulgated, according to our agreement with Kenny Whitlock."

That isn't being done, Busfield contends. Neither his organization nor the non-hospital home health agencies had any input into a draft of regulations received recently, he says.

Whitlock says the proposed regulations will go before the Legislative Council's Rules and Regulations Committee, which will hold a public hearing. He expects the rules to be in place by April or May.

But Busfield believes the state's current method of certifying home health aides under Medicare meets all federal requirements "and will continue to do so for the foreseeable future."

Busfield says the "only justification" for Patterson's firm testing home health aides "is that an appropriation bill was amended to provide a source of income to Mr. Patterson's firm outside of the normal state appropriations."

Patterson calls Busfield's memo "slanderous and libelous" and says he "takes great exception" to the assertion that the purpose of Wilson's amendment was to provide a source of income for HCTC.

"This is a quality-of-care issue," Patterson says. "We're trying to make sure home health aides are trained to do what they purportedly can do."

Busfield's memo called the amendment non-germane to a bill dealing with funds for testing nursing home aides as required by the federal government.

The legislation expires June 30, 1993.

"It is absolutely essential that every move be taken to prevent the repassage of this legislation in the 1993 session, thus continuing a needless or wasteful duplication of effort and examination cost," Busfield says. "... There is absolutely no federal mandate for the testing of home health aides by an independent and outside entity as there is for nursing home nurse assistants."
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Title Annotation:Health Care Training Corp.; Nick Wilson
Author:Griffee, Carol
Publication:Arkansas Business
Date:Feb 10, 1992
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