health and wellness for all arizonans azdhs.gov arizona association for home care presentation...

Health and Wellness for all Arizonansazdhs.gov

Arizona Association for Home Care Presentation

Arizona Department of Health ServicesJuly 25, 2015

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Objectives

• State and Federal Regulations Impacting Home Health

• Licensing Requirements• Identification of Top 10 Deficiencies• Focus on the Top 3 Deficiencies








Home Health Challenges• New Home Health Agencies

– Must provide services within the first 12 months of licensing and continue to provide services every licensing period

• Home Health Geographic Areas – Must be within 65 miles of the parent – Licensing Guidance– Branches can be added within the 65 miles – Licensing

Guidance– CMS certification for geographic area must be approved by

the Regional Office– Do not make changes unless you have received approval








Home Health Challenges• Changes of Location

– Requires notification to the State Agency by letter - Licensing– License will be amended to reflect new address– Must submit a Change of Information to CMS via the 855 to

your MAC– Change of Location must be approved by the Regional Office

• Do not move until you receive approval

– When changing location – note request for geographic coverage

– Map of your geographic coverage will expedite decisions








OASIS• State resources– IT Personnel – Technical concerns (602) 542-1277• Claudia Montes• Alina Choudhury

– OASIS• Assist with the determination of the data questions

– Clinical assessments» Shirley Newman (520) 628-6983» Office Surveyor (602) 364-3030








Federal Considerations• Efficiency and Effectiveness Initiatives Overview– Division of Continuing Care Providers

• Focused Survey Process Initiative– Home Health Recertification Surveys

» Increase in Survey Time• Turnover• Old habits• Protocols not followed• Problematic agencies increased• Not meeting patient needs• Fraud








Division of Continuing Care ProvidersFocused Survey Process Initiative

• Focused Standard Recertification– Efficiency– Effectiveness

• Focused on Key areas– Skilled assessment by skilled nursing and therapists– Plan of Care development and implementation– Notifications of physician of changes in patient condition– Coordination of care – Supervision of Staff

• December 2015 complete the analysis of the Pilot









• Plan to reduce home visits and record reviews, based on the size of the agency

• Streamline the process: limited to home visits, associated record reviews and interviews

• Use the FSRS as a proxy to determining compliance with other regulations

• Set up triggers for more extensive review• Similar in concept to the current Level 1 and 2

protocols, but earlier in the process









• This process is not planned for:– Initial surveys– Complaint surveys– Validation surveys– RevisitsWould count as the 36 month recertification survey









• Pilot– 8 States• New Jersey; Illinois; Michigan; Arkansas; Kansas;

Missouri; Colorado; SouthDakota

• Timeline not finalized at this time








Top 10 DeficienciesFederal Top 10

0158 Acceptance of Patients0164 Periodic Review of POC0118 Compliance with Federal/State Local Laws0165 Compliance with Physician Order0168 Skilled Nursing0176 Duties of Registered Nurse0337 Drug Regimen Review0229 Supervision0322 Accuracy of Encoded Data0323 Transmittal of OASIS data

State Top 100450 Care Plan0452 Care Plan0610 Medical Record0440 Care Plan0382 Personnel0370 Personnel0742 Home Health Services0748 Home Health Services0190 Administration0264 Administration








Federal Top 10

0158 Acceptance of PatientsCare follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine. – The regulation requires the HHA to alert the physician to any

changes that suggest a need to alter the plan of care. – If the HHA provides fewer visits than the physician orders, it has

altered the plan of care and the physician must be notified. – This can be accomplished by obtaining a physician's order to

cover the missed visit or notifying the physician, and maintaining documentation in the clinical record indicating that the physician is aware of the missed visit.








Federal Top 10

0164 Periodic Review of POCAgency professional staff promptly alert the physician to any changes that suggest a need to alter the plan of care. – Changes in the patient's condition that require a

change in the plan of care should be documented in the patient's clinical record.








Federal Top 10

0118 Compliance with Federal/State Local Laws– The HHA and its staff must operate and furnish

services in compliance with all applicable Federal, State, and local laws and regulations. If State or applicable local law provides for the licensure of HHAs, an agency not subject to licensure is approved by the licensing authority as meeting the standards established for licensure.








State Top 10

0450 Care PlanR9-10-1207. Care Plan

B. An administrator shall ensure that:1. Home health services are provided to a patient by the home health agency according to the patient ' s care plan;








State Top 10

0452 Care PlanR9-10-1207. Care Plan

B. An administrator shall ensure that:2. The patient ' s care plan is reviewed and updated:a. Whenever there is a change in the patient ' s condition that indicates a need for achange in the type, duration, or frequency of the services being provided;








State Top 10

0610 Medical RecordR9-10-1209. Medical Records

C. An administrator shall ensure that a patient ' s medical record contains:5. Documentation of general consent and, if applicable, informed consent;








RemindersInfection Prevention

R9-10-1206. PersonnelA. An administrator shall ensure that:4. A personnel member, or an employee, a volunteer, or a student who has or is expected tohave direct interaction with a patient, provides evidence of freedom from infectious tuberculosis:b. As specified in R9-10-113.








Reminders

When you accept a patient and services are required for Therapies – You need to be able to provide these services

R9-10-1210. Home Health ServicesF. A home health services director shall ensure that:2. When a patient ' s physician or registered nurse practitioner orders speech therapy, occupational therapy, or physical therapy for the patient, an individual specified in R9-10-1203(C)(6)(a), (c), or (d), as applicable:a. Provides the applicable therapy service to the patient according to the patient ' s care plan;








Reminders36-411. Residential care institutions; home health agencies; fingerprinting; definitions

Home Health agency and as a condition of employment in a home health agency, employees and owners home health agencies or contracted persons who provide direct care, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards.








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