06/15/ AAHC Conference :: Arizona Department of Health Services Update OBJECTIVES ARIZONA DEPARTMENTOF HEALTH SERVICES

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1 Partnering to Create Positive Momentum: Accelerating Productivity. Optimizing Patient Outcomes. Arizona Department of Health Services Update 2012 Annual Conference & Home Care Expo June 15, 2012 OBJECTIVES To review the hot topics in Arizona Department of Health Services, Division of Licensing and the Bureau of Medical Facilities To identify opportunities for improvement in licensing and certification of Home Health Agencies To engage in collaboration ARIZONA DEPARTMENTOF HEALTH SERVICES Operations Strategic Map Administrative Rules Emergency Preparedness and Response Healthcare Associated Infections Partnership for Patients Initiative 1

2 ARIZONA DEPARTMENT OF HEALTH SERVICES ARIZONA DEPARTMENT OF HEALTH SERVICES Will Humble, Director Divisions Behavioral Health Arizona State Hospital Public Health Laboratory Licensing ADHS STRATEGIC MAP Achieve Targeted Improvements in Health Outcomes Impact Arizona s Winnable Battles Integrate Physical and Behavioral Health Promote and Protect Public Health and Safety Strengthen Statewide Public Health Infrastructure Strengthen ADHS Integration, Effectiveness and Adaptability 2

3 ADMINISTRATIVE RULES SB2634 (April 13, 2011) Requires the Department on or before July 1, 2013 To revise rules to reduce costs and streamline the regulatory process for health care institutions, including those providing behavioral health services To facilitate licensure of integrated health programs that provide both behavioral and physical health services REVISE RULES The Department will review all the rules regulating the licensing of health care institutions and will be revising the rules to comply with statutory changes and current practice Tentative timeline Home Health rules-july 2012 Hospice rules-november 2012 Article 1 rules-february 2013 FACILITATE INTEGRATED HEALTH PROGRAMS Goal: One licensed health care institution facility providing both behavioral and physical health One healthcare team Statutes and administrative rules highlight an integrated healthcare delivery model driven by: data, evidenced based guidelines and input from consumers, providers and stakeholders 3

4 WHAT CAN I DO? Draft rules will be posted for review and comments Bureau of Medical Facilities will notify the Association when posted Please review and provide comments using the online Survey Monkey EMERGENCY PREPAREDNESS AND RESPONSE Collaboration with state, tribal and local stakeholders All licensed health care institutions to be working with their respective County Health Departments/Emergency Preparedness and Response Sections EMERGENCY MANAGEMENT PLANS Provide direction to the Agency on how to respond to internal/external emergencies Prepare for continuity of care, including agency and/or patients evacuation and transfer of care Address the needs of the patients and staff during Pre-Evacuation, Evacuation and Reoccupation 4

5 HEALTHCARE-ASSOCIATED INFECTIONS HAI State Coordinator Vinita Oberoi HAI Advisory Committee 4 Subcommittees: Public education Provider education Surveillance Prevention strategies HAI RESOURCES CDC Healthcare Associated Infections (HAI) website: ADHS website for the HAI Advisory Committee: 3 nd Annual Infectious Disease Training Exercise and Strategic Planning: July 31-August 2, 2012 PARTNERSHIP FOR PATIENTS Public-private partnership April 2011 Goals: Keep patients from getting injured or sicker By the end of 2013, preventable hospitalacquired conditions would decrease by 40% compared to 2010 Help patients heal without complication By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to

6 NO PLACE LIKE HOME CAMPAIGN HSAG, ADHS, AZHHA, APIPS Intense 18 month collaborative Care Transitions to Reduce Hospital Readmissions We re Not in Kansas Anymore-Establishing New Normals Thursday September 13, 2012 PATIENT SAFETY INITIATIVE Survey and Certification Group Focus on compliance with these COPs to reduce hospital-acquired conditions (HACs), including HAIs and preventable readmissions 3 Surveyor Worksheets Infection Control Quality Assurance and Improvement Discharge Planning Testing each tool in 3 separate ads/survey-and-cert-letter pdf DIVISION OF LICENSING SERVICES Operations Website Development Online Application Online Complaint Form Release of Information 6

7 DIVISION OPERATIONS Colby Bower, Interim Assistant Director Licensing Programs Behavioral Health Child Care Special Licensing Assisted Living Long Term Care Medical Facilities WEBSITE DEVELOPMENT Online Renewal Applications Medical Facilities- pending Online Complaint Form Release of Public Information Homepage redesign BUREAU OF MEDICAL FACILITIES LICENSING Operations State Licensing/Compliance Renewal Applications Home Health Agency Administration Qualifications Home Health Agency Geographic Area Approval Top 10 State Licensing Deficiencies Medicare Certification/Recertification OASIS Update New Survey Process Update Top 10 Medicare Deficiencies 7

8 OPERATIONS Kathy McCanna, Bureau Chief Team Leaders Connie Belden Linda Ettenborough Mary Sokol Surveyors Support Staff HOME HEALTH AGENCIES IN ARIZONA Health Care Institutions # of Facilities (5/29/12) Medical Facilities 1973 Licensed Home Health Agencies Certified Home Health Agencies RENEWAL APPLICATIONS Renewal Applications are due days before the expiration date of the current license-arizona Revised Statutes (A.R.S.) C. 8

9 RENEWAL APPLICATIONS Notifications 120 day postcard before expiration date of the current license 90 day or postcard reminder 59 day Notice of Late Application with Enforcement Late fee assessment first offense- $ Expired License- Enforcement for Operating Without a License HOME HEALTH AGENCY ADMINISTRATION QUALIFICATIONS R A. 2. Administration A home health agency shall have a governing authority responsible for the agency s operations. The governing authority shall: Appoint an administrator to manage the agency who shall have three years of administrative or supervisory experience which shall include two years of health care experience SUPERVISING PHYSICIAN/REGISTERED NURSE R B.4. Administration The administrator shall organize and manage the agency and shall be responsible for the following: Appointing a supervising physician who has two years of home health experience or a supervising registered nurse who has three years of nursing experience which includes two years in home health care; 9

10 DESIGNEE R B.12. Administration Designating, in writing, a physician or registered nurse who shall have one year of home health experienceto act in the absence of the supervising physician or registered nurse to ensure that supervisor coverage shall be provided during all operating hours of the agency DEFINITIONS Health care- the diagnosis, treatment, and prevention of disease, illness, injury and other physical or mental impairments in humans Home health- health care provided in the patient s home by licensed personnel Home health care- skilled nursing care and other therapeutic services under the supervision of a physician or registered nurse in the patient s home CHANGES IN ADMINISTRATOR, SUPERVISING PHYSICAN/REGISTERED NURSE Changes in Administrator, Supervising Physician/Registered Nurse Must be reported to the Department Agency must Submit a Resume or CV of the appointed Administrator, Supervising Physician/Registered Nurse Department will reviewed for compliance to rules 10

11 HOME HEALTH AGENCY GEOGRAPHIC AREA Initial Application requires a request for geographic area General guideline is mile radius Changes to geographic area requires notification to the Department Department must approve changes including expansion of the geographic area HOME HEALTH AGENCY GEOGRAPHIC AREA Considerations for Approval of Geographic Area Access to care Resources available to the patients Agency supervision plan Available staff to support the needs of patients in the geographic area Services provided by the parent must be able to be provided in the geographic area Available response time to patient needs STATE LICENSING DEFICIENCIES Top 10 State Licensing Deficiencies Arizona Administrative Code, Title 9, Chapter 10, Article 11: Home Health (July 1, 2011 to Current Date) R A.2.e: Informing the patient s physician of changes in a patient s condition and needs 11

12 R A: Providing services in accordance with written plan of care established and authorized by a physician in consultation with patient and health care team R C: Medical record documentation of verbal order and verification within 30 days R A.: Implementation and maintenance of a quality management program R B.6: Plan of Care to include type and frequency of services R A: Must have Governing Authority responsible for operations R A.3.b.i: Governing Authority must meet at least every 6 months R B.7: Compliance with written contracts R C.1: Supervising physician or registered nurse responsible to implement policy and procedures R C: Personnel attendance at orientation and 6 hours in-service training per year 12

13 HOME HEALTH AGENCY MEDICARE CERTIFICATION Arizona Home Health Agencies Number for Recertification: 178 Recertification Survey Timeframe: Every 36 months Recertification Surveys annually: 60 AO Validation Surveys Increasing OASIS UPDATE - Continue to utilize OASIS-C data for Quality Improvement Process - Evidence Based Practice /Standardized Tools - Assessment findings - Transmission of data - OASIS Questions/Answers website: OASIS RESOURCES OASIS Educational Coordinator Kathy McCanna Shannon Mayer Automation Coordinator- Sandy Enkey 13

14 OLD VS NEW SURVEY PROCESS Old Survey Process - Survey Tasks - Data Driven pre-survey preparation based on OASIS Adverse Event Reports and Risk Adjusted Reports - Patient-focused - Structured survey based on #s of patients admitted yearly determined # of home visits and record review. - Interview with patients and families - Skilled services were cited in an extended survey New Survey Process Follow current survey tasks - Continue to use existing data for pre-survey preparation - Focuses on specific standards within conditions most directly related to the delivery of quality care Level 1 and Level 2 - Information gathering is emphasized more from interview, home visits and clinical record - More home visits less record review - Guidance for expanding survey, citing standard and condition level deficiencies SURVEY LEVELS - Standard Survey- - Level 1 Standards mostly related to delivery of quality care including standards under skilled nursing and therapies - Partial Extended Survey- - Extended when questionable deficient practice in Level 1 and/or Level 2 Standards - Additional materials in a partial extended would include review of agency policies and procedures and further interview - Extended survey- - When condition level is cited SURVEYOR PERSPECTIVE More interviews Streamlines process Less record review More home visits with observation and interview Increase in # of partial and extended surveys Focus is still outcome driven and best practice 14

15 COORDINATION OF CARE All personnel furnishing services maintain liaison to ensure their efforts are coordinated effectively: -Much better evidence of coordination with computerized documentation. Watch for all disciplines visiting patient on the same day of the week patient s complain to us! MEDICATION RECONCILIATION Drug regimen review includes all medications the patient is currently taking: One of the most cited tags: Deficient practice found in home visit interview with patient/family: Expectation: medication profile is current and includes all prescription medications and OTC s MEDICATION RECONCILATION Physician is notified promptly of any discrepancies, side effects etc. Responsibility: Skilled nursing and Physical Therapy (if applicable) 15

16 SUPERVISION OF LPN s The HHA furnishes skilled nursing services by or under the supervision of a registered nurse: LPN supervision is expected to assure quality outcomes are achieved LPN supervision is to be documented according to agency policy CMS RECERTIFICATION DEFICIENCIES OCTOBER 1, 2011 TO CURRENT Care follows a written plan of care established and periodically reviewed by Medical Supervision (b)-Staff promptly alert the physician of any changes that suggest a need to alter the plan of care Provision of Skilled Nursing Services (c)-Comprehensive assessment must include a review of all medications the patient is currently using (a)-Group of professional personnel meets frequently to advise the agency on professional issues, participate in the evaluation of agency s program (a)-Plan of Care developed in consultation with agency staff and covers all pertinent diagnoses 16

17 484.18(c)-Drugs and treatments are administered by agency staff only as ordered by the physician Skilled Nursing Services under supervision of a registered nurse Skilled Nursing Services in accordance with the Plan of Care Clinical record is maintained for every patient receiving home health services QUESTIONS?? Licensing Process including applications: Adriana Gonzales, Support Staff Operations and Rules: Connie Belden, Team Leader Statements of Deficiencies, Informal Disputes, Plans of Correction: Mary Sokol, Team Leader Enforcement: Linda Ettenborough, Team Leader 17