The Office of Civil Rights, an agency within the U.S. Department of Health and Human Services, is involved in investigating health care providers, amongst others, to ensure they are compliant with federal law. In response to complaints, the case shown in Box 3-7 was investigated and eventually resolved.

The ability for an informed individual to be able to stay in their own home, rather than be relocated into an assisted living facility or a nursing home, is an endeavor that has become sanctioned by government agencies over the past decade. Medicare has expanded its coverage for home health services to accommodate the provision of the medical services so that patients can get what they need in the environment that they desire. The case discussed in Box 3-7 describes a situation in which a woman, who needed specialized health care, was able to negotiate with the state of Colorado so she could have the quality of life she needs in her own home without being forced to move. Read through the allegation and the disposition of this case. From the point of view of the state of Colorado, create a list of pros and cons for paying for the services this woman needs to stay in her own home. how much money would you need to add to the budget to provide these services for one year? Take into consideration: The average salary for a certified nursing assistant (CNA) in Fort Collins, Colorado (city picked randomly for purposes of this exercise), is $27,039, or roughly $104 per eight-hour shift day. Typically, those in the National Guard must complete duty of one weekend a month and two weeks during the summer. Prudential Aetna Humana Medicaid Medicare 2000 4000 6000 8000 COPD 「 Diabetes Heart failure FIGURE 3-5 Average revenue per patient by diagnosis and by third-party payer

This complaint was filed on behalf of a woman with multiple sclerosis. The complainant, who lives at home, alleged that the state's policies put her at risk of unnecessary institutionalization because she could not obtain the daily and overnight care she needed to continue living in her home when the complainant's husband was carrying out responsibilities related to his National Office for Civil Rights (OCR) worked with the state and the complainant to resolve the issues in this matter. The complainant began receiving two additional certified nursing assistant (CNA) visits a day when her husband is away for National Guard duty. The complainant found this level of care adequate for her needs. The state also provided information as to the complainant's options should she believe that the level of home health care services she receives is inadequate. The complainant continues to receive Medicaid waiver services, including cleaning, meal preparation, and the use of certain medical equipment.

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