PATIENT RIGHTS: MEETING THE PROPOSED CONDITIONS OF PARTICIPATION JUNE 2016 2 Selman Holman & Associates, LLC Home Health Insight Consulting, Education and Products CoDR Coding Done Right CodeProUniversity 606 N. Bell Ave. Denton, Texas 76209 214.550.1477 972.692.5908 fax Lisa@selmanholman.com Teresa@selmanholman.com www.selmanholmanblog.com www.selmanholman.com www.codeprou.com 2016, S-H&A Teresa Northcutt, BSN RN HCS-D HCS-H COS-C Objectives Understand proposed Conditions of Participation requirements related to patient rights State strategies to meet new CoP requirements Identify key documentation points to satisfy patient rights CoP 4 Patient rights Four New CoP s Care planning, coordination of services and quality of care Quality assessment and performance improvement (QAPI) Infection prevention and control
Notice of Rights 5 Ensure patient safety Proposed Conditions of Participation Patient Rights 484.50 Improve patient outcomes 6 HHA must provide patient and patient s representative with verbal notice of patient rights in the primary or preferred language of patient, and in a manner that the individual can understand, during the initial evaluation visit, and in advance of providing care. Notice of Rights Notice of Rights 7 HHA must provide language assistance services at no cost to patient, and provide notice of the availability of this assistance Patient may choose their own interpreter Document offer and refusal of professional interpreter as evidence of compliance HHA must provide written copy of patient rights information either in English or in the patient s preferred language Provide in alternate formats for patients with disabilities, at no additional cost to patient 8 HHA must provide patient with specific business contact information for agency administrator HHA must provide a copy of the OASIS privacy notice to all patients from whom OASIS data are collected HHA must obtain patient s or representative s signature confirming receipt of a copy of the notice of rights and responsibilities
Exercise of Rights Rights of the Patient 9 In the event a patient is declared incompetent by state Court, the rights of that patient could be exercised by the person appointed by the state Court There are many circumstances where patients may be partially or fully unable to participate in their care decisions; agencies must allow patient s to participate to the degree they are able and interested in doing so, and ensure patient choice is respected while patient safety is assured 10 Patient has the right to have his property and person treated with respect Patient has the right to be free from verbal, mental, sexual and physical abuse, including injuries of unknown source, neglect, and misappropriation of property If injury is identified, HHA is expected to investigate cause and take action to prevent further injury from same source Rights of the Patient Rights of the Patient 11 Patient has the right to make complaints to the HHA about care that was or was not provided, and any care that they believe was inappropriate Patient and/or their representative has the right to participate in, be informed about, and to consent or refuse care; includes participation in assessment of needs, setting patient goals, and care preferences Comprehensive assessment must focus on the patient s goals and preferences specific to the delivery of home health care 12 Patient has the right to receive a copy of his individualized HHA plan of care to be kept in his home, including all updated plans of care. HHA must inform patient of any changes in care prior to those changes being made in POC. HHA expected to provide notice using ABN and NOMNC to retain payment liability protection Patient has the right to be informed of and to access the expedited review process
Rights of the Patient Transfer and Discharge 13 Patient has the right to be informed of the availability of the toll-free home health hotline in their state, including phone number and hours of operation HHA must provide a list (name, address, phone number) of federal, state and local organizations that provide consumer information and protection relevant to the needs of the HHA s patient population Patient has the right to be free of discrimination or reprisal for complaints Patient has the right to be informed of their right to access auxiliary aids and language services 14 New Standard All patients and representatives have the right to be informed of the HHA s policies governing admission, transfer and discharge in advance of the agency providing care Transfer and Discharge Transfer and Discharge 15 Criteria for transfer, discharge or termination of care: HHA can no longer meet patient s acuity needs Patient or payer can no longer pay for HHA services Physician and HHA agree patient no longer needs HHA services due to improved/stabilized health status Patient refused services or elected to be transferred or discharged (including to hospice) When there is cause When patient dies When HHA ceases operations 16 Discharge for Cause is permitted if patient s (or other person in patient s home) behavior is so disruptive, abusive, or uncooperative that delivery of care or ability of HHA to operate effectively and safely is seriously impaired HHA must 1-advise patient, representative, certifying physician, PCP or other health care provider responsible for services after HHA discharge that discharge for cause is being considered; 2-take reasonable steps to resolve safety/noncompliance issues prior to DC; 3- document problem(s), efforts made to resolve, etc. into the HHA clinical record
Investigation of Complaints Investigation of Complaints 17 HHA must investigate ALL complaints made by patients, representatives, families, and caregivers Must document the complaint, the investigation and resolution of complaint Must take immediate action to prevent further potential abuse while investigating Must establish policies and procedures for documenting and resolving complaints 18 All HHA staff (direct or contract) are required to immediately report to the HHA administrator or other appropriate authorities any incidences of mistreatment, neglect or abuse, and/or any misappropriation of patient property, which they notice during the course of providing services to patients. Appropriate authorities: state and local law enforcement, health care ombudsmen, State survey agencies, etc. Accessibility 19 New Standard Information provided to patients must be in plain language, and in a manner that is both accessible and timely to the individual Disabilities use of accessible web sites, provision of auxiliary aids and services (qualified interpreters, alternate formats) Limited English Proficiency (LEP) provision of oral interpretation and written translations 20 Strategies to Ensure Patient Rights
Written Forms Written Forms 21 Patient Rights information All listed rights, availability of language assistance or aids Must have signatures HHA administrator contact info State home health hotline info Alternate languages r/t HHA s patient population Notice of OASIS privacy rights 22 Advanced beneficiary notice (ABN) Notice of Medicare non-coverage (NOMNC) Updated list of federal, state and local resources and organizations Copy of agency policy and criteria for admission, transfer and discharge Policies and Procedures Policies and Procedures 23 P&P for provision/explaination of patient rights at initial evaluation visit P&P for who may exercise rights in lieu of patient; full / partial sharing of rights P&P for informed consent P&P for informed refusal of care P&P governing admission, transfer and discharge 24 P&P for care planning with patient and family participation P&P for progress evaluation and keeping patient informed on POC changes P&P for use of ABN, NOMNC forms P&P for expedited review request response P&P for complaint identification, reporting, investigating and reporting to authorities
Policies and Procedures Informed Refusal of Care 25 P&P for discharge for cause P&P for use of interpreter Identification of need Resources Validation of understanding 26 Applies to: Refusal of admission to HHA Refusal of needed/ordered disciplines Refusal of services before goals met Two part process: Provide and explain info to patient Obtain patient signature to validate agreement and understanding (BP) Informed Refusal of Care Informed Refusal of Care 27 28 Patients don t know what they don t know Provide information on services ordered or recommended by physician Educate patient/family on benefits of treatment, risks of not treating Provide opportunity for questions and discussion of options Review circumstances of refusal of care If a patient, patient representative or family member validly refuses treatment, it is not abuse or neglect if HHA does not provide that care HHA must inform ordering physician of patient refusal and circumstances
Document at SOC 29 Documentation Points 30 Patient s native language and ability to comprehend and effectively communicate in English Use of interpreter (name and contact) Offer and refusal of professional interpreter Patient disabilities that affect communication and understanding Offer of alternate formats or aids specific to disabilities Patient verbal understanding of patient rights information, validated by signature on form 31 Document at SOC Provision of HH hotline info and list of resource organizations Provision of agency policy on admission, transfer and discharge In cases of partial/full incompetence or request for another to exercise rights: Description/reason for incompetence Designated representative and rights they will be responsible for exercising 32 Document at Comprehensive Assessment and Visits Patient s goals and preferences for care delivery Copy of individualized POC provided to patient (ensure copy in home folder) Updates or changes to POC (changes made on home copy)
Document the Following Document for Informed Refusal 33 Applicable forms for ABN, NOMNC In cases of discharge for cause: Description of problem(s) Notification of patient, representative, certifying physician, PCP or other health care provider responsible for services after HHA discharge that discharge for cause is being considered Steps taken to resolve safety and/or noncompliance issues prior to DC and patient/family s response to efforts 34 Must document in medical record: Information provided to patient on services recommended Discussion and questions addressed, explanation of benefits and potential risks of not receiving services Circumstances of refusal use patient s own words and reasons refusing care Document for Complaints What questions do you have? 35 The complaint, who made it, date/time The investigation process and findings Any action taken to prevent further potential abuse while investigating Outcome of investigation: Resolution of complaint, or inability to resolve issues and circumstances Communication back to person who made complaint with satisfaction or other action Notification of authorities if indicated Lisa@selmanholman.com Teresa@selmanholman.com Selman-Holman & Associates, LLC Home Health Insight CoDR Coding Done Right home health and hospice outsource for coding and coding audits CodeProUniversity role based comprehensive online ICD-10-CM training for home health and hospice