1. Health and Wellness for all Arizonans azdhs.gov Arizona Association for Home Care Presentation Arizona Department of Health Services July 25, 2015

2. Health and Wellness for all Arizonans azdhs.gov Objectives State and Federal Regulations Impacting Home Health Licensing Requirements Identification of Top 10 Deficiencies Focus on the Top 3 Deficiencies

3. Health and Wellness for all Arizonans azdhs.gov 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

4. Health and Wellness for all Arizonans azdhs.gov 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

5. Health and Wellness for all Arizonans azdhs.gov 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

6. Health and Wellness for all Arizonans azdhs.gov 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

7. Health and Wellness for all Arizonans azdhs.gov Division of Continuing Care Providers Focused 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

8. Health and Wellness for all Arizonans azdhs.gov Division of Continuing Care Providers Focused Survey Process Initiative 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

9. Health and Wellness for all Arizonans azdhs.gov Division of Continuing Care Providers Focused Survey Process Initiative This process is not planned for: – Initial surveys – Complaint surveys – Validation surveys – Revisits Would count as the 36 month recertification survey

10. Health and Wellness for all Arizonans azdhs.gov Division of Continuing Care Providers Focused Survey Process Initiative Pilot – 8 States New Jersey; Illinois; Michigan; Arkansas; Kansas; Missouri; Colorado; SouthDakota Timeline not finalized at this time

11. Health and Wellness for all Arizonans azdhs.gov Top 10 Deficiencies Federal Top 10 0158 Acceptance of Patients 0164 Periodic Review of POC 0118 Compliance with Federal/State Local Laws 0165 Compliance with Physician Order 0168 Skilled Nursing 0176 Duties of Registered Nurse 0337 Drug Regimen Review 0229 Supervision 0322 Accuracy of Encoded Data 0323 Transmittal of OASIS data State Top 10 0450 Care Plan 0452 Care Plan 0610 Medical Record 0440 Care Plan 0382 Personnel 0370 Personnel 0742 Home Health Services 0748 Home Health Services 0190 Administration 0264 Administration

12. Health and Wellness for all Arizonans azdhs.gov Federal Top 10 0158 Acceptance of Patients periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine. Care 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.

13. Health and Wellness for all Arizonans azdhs.gov Federal Top 10 0164 Periodic Review of POC Agency 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.

14. Health and Wellness for all Arizonans azdhs.gov 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.

15. Health and Wellness for all Arizonans azdhs.gov State Top 10 0450 Care Plan R9-10-1207. 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;

16. Health and Wellness for all Arizonans azdhs.gov State Top 10 0452 Care Plan R9-10-1207. 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 a change in the type, duration, or frequency of the services being provided;

17. Health and Wellness for all Arizonans azdhs.gov State Top 10 0610 Medical Record R9-10-1209. Medical Records C. An administrator shall ensure that a patient ' s medical record contains: 5. Documentation of general consent and, if applicable, informed consent;

18. Health and Wellness for all Arizonans azdhs.gov Reminders Infection Prevention R9-10-1206. Personnel A. An administrator shall ensure that: 4. A personnel member, or an employee, a volunteer, or a student who has or is expected to have direct interaction with a patient, provides evidence of freedom from infectious tuberculosis: b. As specified in R9-10-113.

19. Health and Wellness for all Arizonans azdhs.gov 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 Services F. 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;

20. Health and Wellness for all Arizonans azdhs.gov Reminders 36-411. 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.

21. Health and Wellness for all Arizonans azdhs.gov THANK YOU Questions Comments