Expert answers agency questions about final home health interpretive guidelines

Source: Home Health Line

Following a recent DecisionHealth webinar about the final interpretive guidelines for the revised Home Health Conditions of Participation (CoPs), agencies asked questions of industry expert Diane Link, owner of Link Healthcare Advantage. Here are some of Link’s answers.

Q: What is your biggest takeaway from the final interpretive guidelines? What is the biggest change and how should we as agencies be addressing it?

A: The most concerning issue is the statement that issues of accessibility or potential discrimination should be referred to the Office of Civil Rights. It just empowers the surveyor to make a report. Not that surveyors didn’t have the right to do so before, but when it’s spelled out that way it really raises a concern. My second-biggest takeaway is that the verbal rights of the patient must be done on that first visit before hands-on care is done.

Q: Will the final interpretive guidelines change the way surveyors are conducting surveys or what they are citing? If so, how?

A: Absolutely. These interpretive guidelines are the surveyor’s script. This is what they do when they conduct surveys. É Especially now that surveyors and the industry are getting used to these rules and now that we have firm guidelines, it’s going to change the way that surveyors are doing it. Surveyors are going to be looking for things specifically, such as was that verbal notice done. They are going to be looking in that patient’s folder and making sure there is required written information. They are going to be looking for coordination with the physician on all of the orders agencies are taking. They’re going to be paying more attention to QAPI than they did previously.

Q: Can you clarify when the patient-selected representative should receive notice of the patient’s rights? Does the patient-selected representative need to receive both verbal and written notice of the patient’s rights?

A: In the final interpretive guidelines, CMS removed the requirement to provide verbal notice of patient rights to the patient-selected representative within two days. But CMS kept the reference requiring the patient-selected representative be provided a written copy of the patient’s rights within four business days of the initial evaluation visit. The only way around providing the patient-selected representative with the written copy of the patient’s rights notice is if the patient says he or she does not want the representative to receive the written copy.

Q: In the QAPI requirement ¤484.65, what does CMS mean by “including the prevention and reduction of medical errors?”

A: We are assessing and observing if we have an issue related to medical error. Tie it to the adverse event report found in CASPER. Agencies are required to track their adverse events as part of the QAPI plan. If, for instance, the agency notices through monitoring of that report that a high number of patients are going back to the hospital due to medication issues, the agency should put a plan in place to reduce that medical error.

Editor’s note: To purchase an audio version of the February webinar replay, visit https://store.decisionhealth.com/mastering-interpretive-guidelines-020719. It will be available for a year after being purchased.

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