Does your home care agency provide services to Medicaid clients?

Yes

No

If Yes, to your knowledge, have any clients of your agency been solicited by new fiscal intermediary GT Independence or asked to enroll as employees?

Yes

No

If Yes, have you lost any clients as a result?

Yes

No

Not sure

Does your home care agency perform a safety check of the client’s home for the protection of caregivers prior to providing services to a client?

Yes

No

Does your agency use any guidelines to perform such a safety check? Select all that apply.

We check for smoke detectors

We check for fire extinguishers

We check for firearms

No, we do not use any guidelines.

Other (please specify)

Comments.