1. State Licensing, Survey, and OASIS Updates Jada Lynn, BSN, RN Jane Hawk, DNP, RN John Hilger, MSW Patricia Terry, MPA, RN

2. In-Home Services (IHS) Program The IHS program is organized into two key areas: Licensing, rules, and policy (“Program”) Inspections and complaint investigations IHS licensing, rules, and policy is managed by John Hilger IHS inspections & investigations is managed by (TBA)

3. IHS Licensing Update The department’s In-Home Services license allows licensees to choose either a single service category or a combination of categories they want to offer: Home Care Home Health Hospice Hospice Care Center

4. Licensing Update Continued The following licensing numbers were accurate as of March 20, 2015. 434 “active” In-Home Services licenses 25 “pending” In-Home Services licenses

5. Licensing Update Continued Service Category Breakdown: 255 Home Care Agencies 207 Home Health Agencies 35 Hospice Agencies 9 Hospice Care Centers These category numbers won’t add up to the 434 licenses because one agency can have multiple service categories.

6. Licensing Update Continued Number of Medicare Certified agencies: 64 Medicare Certified Home Health Agencies 31 Medicare Certified Hospice Agencies 9 Medicare Certified Hospice Care Centers 70 DSHS contracted Home Care Agencies

7. Investigations Update State investigations data for 2014 calendar year 80 State Investigations The majority of complaints involve home care agencies 62 out of 80 complaints involved allegations of poor standards of care 8 out of the 80 complaints were allegations of unlicensed agencies

8. Survey Team The department has five dedicated In-Home Services surveyors: Jada Lynn, BSN, RN Lori Barney, MN, RN Patricia Terry, MPA, RN Sarah Benson, BSN, RN Suzanne Kinchen, BSN, MPH, RN

9. OASIS Updates

10. Outreach Education Webinars Non-Pressure Ulcer skin M-items Wednesday, May 20 @ 10-11am Wednesday, May 27 @ 1p-2p [Encore presentation] Invites sent via email last month OASIS Version C1/ICD-10 Wednesday, September 16 @ 10-11am Wednesday, September 23 @ 1p-2p [Encore presentation] Invitations will be emailed in August OASIS Test Your Knowledge Q&As 2 Q&As sent via email in Feb, May, August & November OASIS FAQs Read OASIS Q&As from WA providers; next issue: April OASIS Bulletins Spring, Summer, Fall

11. ICD-10 New CMS web site info on ICD-10: http://www.cms.gov/Medicare/Coding/ICD10/ind ex.html?redirect=/icd10 http://www.cms.gov/Medicare/Coding/ICD10/ind ex.html?redirect=/icd10 Sign up for ICD-10 Email Updates: http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD- 10_Industry_Email_Updates.html http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD- 10_Industry_Email_Updates.html ICD-10 Resources Flyer: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Resour cesFlyer20141105.pdf http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Resour cesFlyer20141105.pdf http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html IDC-10 Fact Sheet: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introd uction20140819.pdf http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introd uction20140819.pdf

12. ASAP Updates QTSO Memos 2015-004: OASIS Assessment Submission and Processing (ASAP) System Enhancements Enhancements to correct the editing of M0016 Branch ID Number field 2015-007: OASIS records Rejected Due to Error -4700 or -4710 Addresses inconsistencies between the Branch ID data in the state database and the Branch ID in national database 2015-016: OASIS ASAP Error – 4820 Invalid HIPSS code Warning message; record will be accepted Enhancement for this error will occur with Oct. 1 update

13. Resources OASIS Submission User’s Guide OASIS Quarterly Q&As Home Health Care Agency Systems User’s Guide https://www.qtso.com/hhatrain.html Error Messages https://www.qtso.com/download/Guides/hha/user/Users_sec5_14.pdf QIES Help Desk Help@QTSO.com 800-339-9313

14. Survey Updates

15. State Inspections Surveys Data per Calendar Year January 1, 2014 thru December 31, 2014 Agencies surveyed in calendar year for all categories of In-Home Licensing: 271

16. Most Frequent Citations State Home Care WAC 246-335-105 Supervision of home care (41) Z 2080 Every 6 months To assess client satisfaction To assess aide compliance with the plan of care WAC 246-335-060 Delivery of Care (40) Z 0720 Reporting of abuse/neglect WAC 246-335-070 Personnel Records (40) Z 0970 Annual performance evaluations WAC 246-335-070 Personnel Records (31) Z 0920 Verification of skills

17. Most Frequent Citations State Home Care Supervision of Home Care *Reporting of Abuse/Neglect *Annual Performance Reviews *Verification of Skills

18. Most Frequent Citations State Home Health WAC 246-335 060 Delivery of Services (40) Z 0720 Reporting of Abuse and Neglect WAC 246-335-070 Personnel Records (40) Z 0970 Annual evaluations WAC 246-335-070 Personnel Records (31) Z 0920 Verification of skills WAC 246-335-070 Personnel Records (25) Z 0930 Evidence of disclosure checklist and criminal background checks

20. Most Frequent Citations State Home Health *Reporting of Abuse/Neglect *Annual Performance Reviews *Verification of Skills *Evidence of Disclosure Statement

21. Most Frequent Citations State Hospice WAC 246-335-075 Bill of Rights (7) Z 1120 Bill of Rights are implemented and updated WAC 246-335-110(1)(c )(ii) Patient/client records (5) Z 2190 Consent for service, care, and treatment WAC 246-335-085 (1)(c )(ii), (vii) Hospice Plan of Care Z 1490 Include goals and outcome measures on Plan of Care (4) Z 1540 Include special nutritional needs and food allergies (1)

22. Most Frequent Citations State Hospice Bill of Rights Consent for Service Hospice Plan of Care

23. Medicare Surveys Survey Data per Calendar Year January 1, 2014 thru December 31, 2014 Medicare surveys for Home Health: 43 Medicare survey for Hospice: 5

24. Most Frequent Citations Medicare Home Health Care Follow Written Plan of Care: G 158 Supervisory Visits Every two Weeks: G 229 Initial Assessment w/in 48 Hrs of Referral: G 332 Comply With Professional Standards & Principles: G 121

25. Most Frequent Citations Medicare Home Health 484.18 Condition of Participation: Acceptance of Patients, Plan of Care, and Medical Supervision G 158 (Level One citation) (7) “Care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.” This citation is specific to ‘missed visits’ as referenced in the Interpretive Guidelines.

26. Most Frequent Citations Medicare Home Health 484.36 Condition of Participation: Home Health aide services. G 229 (Level One citation) (6) “The registered nurse (or another professional described in paragraph (d)L(1) of this section) must make an on-site visit to the patient’s home no less frequently than every 2 weeks.”

27. Most Frequent Citations Medicare Home Health 484.55 Condition of Participation: Comprehensive assessment of patients G 332 (Level One citation) (6) Initial assessment within 48 hours of referral or 48 hours of patient’s return home, or on the physician-ordered start-of-care date.

28. Most Frequent Citations Medicare Home Health 484.11 Condition of Participation: Compliance with Federal, State and local laws, disclosure, ownership information, accepted professional standards and principles. G 121 (Level One citation) (4) The HHA and its staff must comply with accepted professional standards and principles that apply to professionals furnishing services in an HHA Reporting of Abuse and Neglect (1) Criminal background checks and Disclosure checklist (1) Infection control practices (2)

29. Medicare Hospice Surveys Survey Data per Calendar Year January 1, 2014 – December 31, 2014 418.54 CoP: Initial and comprehensive assessment L 521 “The hospice must conduct and document in writing a patient-specific comprehensive assessment” 418. 56 CoP: Interdisciplinary group, care planning and coordination of services L 543 (Standard) “All care/services follow individualized plan of care”

30. Medicare Hospice Surveys 418. CoP: hospice aide and homemaker services L 629 (Standard) RN on-site visit (i) every 14 days/aide presence not required 418.78 CoP: Volunteers L 645 (Standard) Recruiting and retaining of volunteers L 646 Cost savings by using volunteers L 947( Standard) Volunteer activity equals 5% of total patient care hour

31. Medicare Hospice Surveys 418.108 CoP: Short-term patient care L 715 Hospice responsible for training personnel 418.110 CoP: Hospices that provide inpatient care directly L 737 (Standard) Right to be free from physical and mental abuse/restraint/seclusion 418.112 CoP: Hospices that provide hospice care to resident of a SNF/NF or ICF/MR (facility) L 771 Report alleged violations/unrelated to hospice/in 24 hours

32. Medicare Hospice Surveys 418.114 CoP: Personnel qualifications L 796 (Standard) Criminal background checks in accordance with State law/3 months from employment 418.116 CoP: Compliance with Federal/State/local laws L 798 Operate in compliance with above laws

33. Questions?