home health care agency

212 Pages·2014·1.59 MB·English

by  Julie Gorham

Divine Home Care TABLE OF CONTENTS
A comprehensive listing of the policies and procedures in numeric order can be
referenced under the Crosswalk tabbed section of this manual.
SECTION C: CLIENT CARE
Abuse Prevention Plan C-560
Admission Policy C-120
Advance Beneficiary of Non-Coverage Notice C-123A
Advance Directive Policy C-430
Advance Directive Procedure C-435
Adverse Medication Reaction C-730
Anticoagulant Therapy C-715
Care Plans C-660
Client Admission Process C-140
Client and/or Family Responsibilities C-390
Client Discharge Process C-500
Client/Family Education C-400
Client/Family Complaint/Grievance Policy C-381
Client Identification C-210
Client Information Required for Medication Management C-704
Client Privacy Rights C-382
Client Reassessment/Update of Comprehensive Assessment (SCIC) C-155
Client Requests for Restrictions on Use and Disclosure of PHI C-388
Client Security and Privacy C-900
Client Transfer C-840
Clinical Documentation C-680
Clinical Record Confidentiality C-880
Clinical Records/Medical Record Retention C-870
Clinical Record Removal C-420
Clinical Supervision C-300
Code of Ethics C-510
Communication with Limited-English-Proficient Persons C-860
Communication with Sensory-Impaired Clients C-850
Comprehensive Client Assessment C-145
Consent for Use and Disclosure of Protected Health Information C-386
Consent for Filming or Recording C-610
Controlled Substances C-740
Coordination of Client Services C-360
County Medical Examiner Notification of Impending C-480
Death of Home Health Care Client
Delegation of Nursing Tasks C-350
Discharge Summary C-820
Discontinuation of Life-Sustaining Treatment C-490
Documentation of Changes to the Medical Records C-873
Electronic Signature C-872
Emergency Care C-655
End of Life Care C-440
Ethics Committee C-530
Extended Hours of Service C-280
Face to Face Encounter C-590
Divine Home Care TABLE OF CONTENTS
Fall Prevention Program C-146
First Dose Medication Therapy C-750
Flow Sheets C-710
Handling of Clients’ Finances and Property C-895
Hand Off Communication C-365
Home Care Bill of Rights C-380
Home Health Change of Care Notice C-123
Home Health Aide Care Plan C-751
Home Health Aide Medication Administration Procedure C-760
Home Health Aide Services C-220
Home Health Aide Supervision C-340
Home Health Aide: Assignment C-780
Home Health Aide: Documentation C-800
Identifying and Reporting Abuse/Neglect/Exploitation of Clients C-540
Investigational Medications C-620
Licensed Practical Nurse Supervision C-320
Medical Social Services C-260
Medical Supervision C-645
Medicare Qualifying Criteria for Beneficiary Reimbursement C-122
Medication Administration C-708
Medication Administration by Home Health Aides C-755
Medication Administration Error C-720
Medication Labels C-707
Medication Management C-705
Medication Orders C-706
Medication Profile C-700
Medication Reconciliation C-709
Medication Set Up Policy C-701
Notice of Privacy Practices C-384
Notice of Medicare Non-Coverage C-124
Obtaining and Renewing DNR/DNI Orders C-460
Pain Assessment and Management C-148
Physician Orders C-635
Physician Summary C-650
Plan of Care C-580
Provision for 24-Hour RN Availability C-180
Release and Disclosure of Information C-125
Reporting of Critical Values C-370
Restraints C-625
Section 504 Grievance Procedures C-422
Service Agreement C-160
Services on Hold C-630
Services Provided C-100
Skilled Nursing Services C-200
Standards of Practice C-110
Supervision of Staff C-315
Therapy Services C-240
Voluntary Informed Consent C-600
Divine Home Care
C-100
SERVICES PROVIDED
Agency will provide intermittent, part-time or extended hours of skilled nursing and
home health aide services to clients in their places of residence. The intermittent or
part-time services shall be provided on a visiting basis. Agency will also provide
Physical Therapy, Speech Therapy, Occupational Therapy, and Medical Social
Services on a visiting basis to clients in their places of residence. At least one (1) of
the qualifying services will be provided directly through agency employees. The
second qualifying service and additional services may be provided under arrangements
with another agency or organization.
If, for medical or safety reasons, a service to be provided must be completed at the
scheduled time, and the Agency is unable, for any reason, to keep the scheduled
appointment, arrangements will be made to complete the service through a contract
with another provider or through other reasonable means.
Services shall be available seven (7) days a week, twenty-four (24) hours per day.
On-call nurses will carry pagers/cell phones for contact in the event of an emergency
and will be available supplied twenty-four hours per day, seven days a week.
Services will be coordinated by the Registered Nurse/Therapist managing the care.
This will include implementing, revising, and updating the Plan of Care; physician
conferencing; scheduling of visits; supervision of health team members; and
conferencing with health team members to plan and evaluate client care.
All services not furnished directly, are monitored and controlled by the parent agency.
Appropriate administrative records shall be maintained for each Branch.
The qualifications and competence of the individual(s) providing service are
appropriate to client needs and the required services and comply with applicable laws
and regulations.
The Agency will provide services to clients in the following county service area:
Crow Wing, Morrison, Stearns, Pope, Stevens, Grant, Traverse, Big Stone, Swift,
Chippewa, Kandiyohi, Meeker, Wright, McLeod, Renville, Redwood, Yellow
Medicine, Lincoln, Lyon, Murray.
Agency maintains business hours Monday through Friday, 9:00 a.m. to 5:00 p.m.,
except during holidays or as authorized by the Administrator.
Divine Home Care
C-100

Statement of Home Care Services
Comprehensive Home Care Provider

Divine Home Care, Inc.
Comprehensive Home Care Provider Name:

Below is a list of all services that may be provided with a Comprehensive Home Care License. Each
service that is offered by this provider is indicated by a check next to the service.

 Advanced Practice Nurse Services  Complex or Specialty Healthcare Services

 Registered Nurse Services  Assistance with dressing, self-feeding, oral
hygiene, hair care, grooming, toileting, and
 Licensed Practical Nurse Services bathing

 Physical Therapy Services  Providing standby assistance within arm’s
reach for safety while performing daily
 Occupational Therapy Services activities

 Speech Language Pathologist Services  Providing verbal or visual reminders to take
regularly scheduled medication (includes
 Respiratory Therapy Services bringing clients previously set-up medication,
medication in original containers, or liquid or
 Social Worker Services food to accompany the medication)

 Services by a Dietitian or Nutritionist  Providing verbal or visual reminders to the
client to perform regularly scheduled
 Medication Management Services treatments and exercises

 Delegated tasks to unlicensed personnel  Preparing modified diets ordered by licensed
health professional
 Hands-on assistance with transfers and
mobility  Laundry

 Providing eating assistance for clients  Housekeeping/Other household chores
with complicating eating problems (i.e.
difficulty swallowing, recurrent lung  Meal preparation
aspirations, or requiring the use of a
tube, parenteral or intravenous  Shopping
instruments)
Divine Home Care
C-110
STANDARDS OF PRACTICE
POLICY
Agency will provide services that are in compliance with acceptable professional
standards for the Home Care industry as well as all state and federal laws, State
Practice Acts, and identified agency performance improvement standards.
PURPOSE
To identify and define the accepted standards of practice Agency is committed to
following in the providing home care services to our clients.
SPECIAL INSTRUCTIONS
1. The agency staff will practice within the guidelines of their stated discipline.
2. All staff will be knowledgeable regarding laws and regulations governing home
health care.
3. Client care will be provided under the Plan of Care established by a physician
when required by law and regulation that does not discriminate based on client’s
race, national origin, disability or handicap, sexual orientation, age, or sex.
4. Agency staff will deliver services based on each client’s unique and individual
needs, and clinical decisions will not be altered solely based on reimbursement
source or compensation plan. Care will be provided in a coordinated, effective,
appropriate, cost-conscious, and safe manner in accordance with agency goals,
objectives, and philosophy.
Divine Home Care
C-120

ADMISSION POLICY
POLICY

Clients are accepted for treatment in the home on the basis of reasonable criteria and
under the expectation that the client’s medical, nursing, and social needs can be met
adequately by Agency in the client’s place of residence.
Agency shall make available and provide services to all persons without regard to
race, color, creed, sex, national origin, handicap, sexual orientation, age, marital
status, status with regard to public assistance or veteran status, in compliance with
45CFR parts 80, 84, 91, and other agency guidelines. All services are available
without distinction to all program participants, regardless of diagnosis. Agency shall
not deny admission to people with a contagious disease, including, but not limited to
HIV, MRSA, and Hepatitis. All persons and organizations that either refer persons for
services or recommend the agency’s services shall also be advised of same.
The person designated to coordinate the agency’s compliance with Section 504 of the
Rehabilitation Act of 1973 (nondiscrimination against the handicapped) is
Alison Mulder, Nursing Director

who can be reached at 320-231-9757.
PURPOSE

To provide guidelines for accepting clients for home health care services to be
provided in the client’s place of residence that are clear to the home care staff, the
medical and lay community, and that abide by state/federal guidelines.
To comply with Title VI of the Civil Rights Act of 1964, Section 504 of the
Rehabilitation Act of 1973, The Age Discrimination Act of 1975, all the requirements
imposed by, or pursuant to, the regulations of the Department of Health and Human
Services (45CFR Parts 80, 84, and 91) issued pursuant to these statutes and other
agency guidelines.
Divine Home Care
C-120

SPECIAL INSTRUCTIONS

Criteria for Client Admission:
1. A direct request for service shall be made to the agency. It may be generated by a
client, physician, caregiver, health facility representative or community member.
2. The client must live in the geographic area served by the Agency.
3. Services for a client receiving Skilled Nursing, Therapy, Medical Social Services
or Home Health Aide services must follow a written Plan of Care established and
periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.
The written Plan of Care shall be reviewed at least every 60 days by that
physician or their designee.
4. There must be a reasonable expectation that the client’s medical, nursing, social,
or rehabilitation needs can be adequately met in the client’s home.
5. Reasonable expectation shall consider:
a. Whether the agency’s personnel and resources are adequate and suitable for
providing the services the client requires.
b. The attitudes of client/caregiver toward care at home.
c. The benefits of care at home as compared to care in a hospital, extended care
facility or alternate setting.
d. Whether the physical facilities in the client’s home are adequate
for giving the client proper care.
6. There is indication that the delivery, monitoring and coordination of home health
care services will enable the client to remain within the home environment.
7. When determined necessary based on the client’s condition, a competent
caregiver and/or family member may assume responsibility for client care with
intermittent services provided by the agency.
8. Medicare beneficiaries must meet the qualifying criteria identified in the
Conditions of Participation for the agency to receive payment for services from
Medicare (Policy C-122).
9. The client must be entitled to receive covered home health services under the
Health Insurance for the Aged Act, Title XVIII and/or Title XIX of the Social
Security Act (Medicare and Medicaid), or have other funding sources, i.e., private
insurance, HMO, or ability to self pay.
10. Agency services must be appropriate and available to meet the specific needs and
requests of the client and caregiver.
Divine Home Care
C-122

MEDICARE QUALIFYING CRITERIA
FOR BENEFICIARY REIMBURSEMENT
POLICY
To accept a client for care under Medicare reimbursement, the client must meet
qualifying criteria as outlined in the HIM-11 (CMS Home Health Agency Manual and
in the CFR 42 S93 Section 409.42).
PURPOSE
To provide written guidelines for determining whether clients qualify for Medicare
reimbursement of home health services.
SPECIAL INSTRUCTIONS
1. The client must be confined to the home or place of residence that is not a
hospital or skilled nursing facility (Homebound.) The client may leave their home
for medical appointments and treatments without compromising home bound
status. Attendance at adult day care does not preclude the client from receiving
Medicare home health services, if indicated.
2. The client must be under the care of a physician who establishes and reviews
the Plan of Care.
3. The client must need at least one of the following skilled services as
certified by the physician:
a. Intermittent skilled nursing.
b. Physical therapy.
c. Speech Language Pathology.
d. Continuing Occupational therapy if the prior need for skilled nursing, physical
therapy, or speech therapy had been established in the current or prior
certification period.
4. The services required or anticipated coverage needed must meet part-time or
intermittent criteria.
5. The services must be reasonable and necessary as determined by client condition,
diagnosis, available caregivers and documentation must also reflect that services
meet this criteria.
Divine Home Care
C-122

6. Physician orders must be present and signed specifying the medical treatments to be
furnished, type, frequency, and duration of services to be provided by discipline(s).
Orders must be reviewed by the physician at least every sixty (60) days.
7. Services must be furnished by a Medicare-certified agency.
8. The client must be eligible for Medicare.
Divine Home Care
C-123
HOME HEALTH CHANGE OF CARE
NOTICE (HHCCN)
Form CMS-10280 (replaces HHABN Option Box 2 and 3)
EFFECTIVE DATE: December 9, 2013

POLICY
The home health agency (HHA) must provide the HHCCN whenever they reduce or
terminate a beneficiary’s home health services due to physician/provider orders or
limitations of the HHA in providing the specific service. Notification is required for
covered and non-covered services when a triggering event changes the beneficiary’s
plan of care (POC). Triggering events are reductions or terminations in care in
accordance with Medicare COPs.
HHCCN Triggering Events At A Glance – Abbreviated Reference Tool
Type of Must be Issued Timing of Notice Optional
Notice: Use?
Change of Prior to the HHA Immediately on determination, No
Care reducing or discontinuing or if possible, provide enough
Notice care listed in the time for the beneficiary to
beneficiary’s plan of care arrange to obtain the reduced
(POC) for administrative or discontinued home health
reasons specific to the care service(s) from a different
HHA on that occasion. HHA.
Prior to the HHA Notify the beneficiary before No
reducing or discontinuing the actual reduction or
Medicare covered care discontinuation, if possible.
listed in the POC because
of a physician ordered
change in the plan of care
or a lack of orders to
continue the care.

 Reductions involve any decrease in items and/or services, such as frequency,
amount, or level of care, provided by the HHA regardless of who is responsible
for paying for that service. When a reduction occurs because the HHA decides to
stop providing the service for administrative reasons or because of a physician’s
order, the HHCCN must be issued.