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Working group to evaluate referral loop, criminal‑background access and behavioral‑health supports; recommends extending the group
Summary
Members recommended evaluating how referral information is transmitted to home‑health agencies, exploring whether referral sources should be required to share safety‑relevant information 'as permitted by law,' and examining access to behavioral‑health support (including ACT teams) for high‑risk home visits.
Participants raised persistent concerns about the "referral loop": how hospitals, emergency services and other referral sources transmit safety and background information to home‑health and hospice agencies.
Several providers said they often receive incomplete information when a patient is discharged or transferred. Tracy (Co‑chair) and other members proposed a recommendation to evaluate the referral loop and to assess whether referral sources who possess safety‑relevant information should be required to share it "as permitted by law." A number of participants cautioned that privacy and legal limits (for example, HIPAA and judicial‑branch access rules) would constrain what can be shared.
The meeting also addressed how to provide behavioral‑health supports for in‑home visits to clients with psychiatric diagnoses or acute behavioral risks. Sasha and others noted that access to behavioral‑health clinicians or ACT (assertive community treatment) teams could reduce risk for front‑line staff. Julianne (Demus representative) and other state staff said the proposed models would have a fiscal impact; DSS and other agencies said they could not support new, unfunded mandates. The group discussed lower‑cost options such as closer partnerships with existing ACT teams, shared on‑call consultative arrangements, and piloting training offered by state behavioral‑health programs.
The working group recommended continuing the committee into 2025 to flesh out these issues and to solicit additional direct‑care staff perspectives. Co‑chairs said they would add a recommendation to "evaluate the referral loop and explore mechanisms for timely, legally permitted sharing of safety‑relevant referral information," and to study collaborations with behavioral‑health teams as a priority for follow‑up work.
Why this matters: incomplete referral data and limited behavioral‑health supports are operational gaps that members said reduce the ability of home‑health and hospice staff to anticipate risks and deploy appropriate personnel or supports.
Next steps: include a recommendation in the report to evaluate the referral loop and judicial/technical barriers to sharing safety‑relevant referral information ("as permitted by law") and to explore pilot collaborations with ACT teams and other behavioral‑health resources.
