TYPES OF SURVEYS Initial Certification 1 Standard Survey 1 Partial Extended Survey 2 Level 1 and Level 2 Standards 2 Extended Survey 3 Recertification Surveys 3 Frequency of Surveys 3 SUBPART A - GENERAL PROVISIONS 4 484.1 Basis and Scope 4 484.2 Definitions 4 Bylaws 4 Branch Office 4 Clinical Note 5 HHA 5 Parent Home Health Agency 5 Primary Home Health Agency 5 Progress Note 5 Proprietary Agency 5 Public Agency 5 Subdivision 5 Subunit 6 Summary Report 6 Supervision 6
484.4 Personnel Qualifications 7 Administrator, Home Health Agency 7 Audiologist 7 Home Health Aide 7 Occupational Therapist 8 Occupational Therapy Assistant 10 Physical Therapist 12 Physical Therapy Assistant 14 Physician 15 Practical (Vocational) Nurse 15 Public Health Nurse 15 Registered Nurse (RN) 15 Social Work Assistant 16 Social Worker 16 Speech-Language Pathologist 17 SUBPART B - ADMINISTRATION 17 G100 484.10 Condition of Participation: Patient Rights 17 G101 Paragraph 1 of 484.10 17 G102 - G103 484.10(a) Standard: Notice of Rights 18 G104 - G105 484.10(b) Standard: Exercise of Rights and Respect for Property and Person 20 G106 - G107 484.10(b) Standard: Exercise of Rights and Respect for Property and Person 20 G108 - G110 484.10(c) Standard: Right to be Informed and to Participate in Planning Care and 21 Treatment G111 - G112 484.10(d) Standard: Confidentiality of Medical Records 24 G113 - G115 484.10(e) Standard: Patient Liability for Payment 24 G116 484.10(f) Standard: Home Health Hotline 26
G310 484.11 Condition of Participation: Release of Patient Identifiable OASIS Information. 26 G117 484.12 Condition of Participation: Compliance With Federal, State, and Local Laws, 29 Disclosure and Ownership Information, and Accepted Professional Standards and Principles G118 484.12(a) Standard: Compliance with Federal, State, and Local Laws and Regulations 29 G119 - G120 484.12(b) Standard: Disclosure of Ownership and Management Information 29 G121 484.12(c) Standard: Compliance with Accepted Professional Standards and Principles 30 G122 - G126 484.14 Condition of Participation: Organization, Services, Administration 32 G127 484.14(a) Standard: Services Furnished 34 G128 - G132 484.14(b) Standard: Governing Body 34 G133 - G137 484.14(c) Standard: Administrator 35 G138 - G140 484.14(d) Standard: Supervising Physician or Registered Nurse 35 G141 484.14(e) Standard: Personnel Policies 36 G142 484.14(f) Standard: Personnel Under Hourly or Per Visit Contracts 36 G143 - G145 484.14(g) Standard: Coordination of Patient Services 37 G146 484.14(h) Standard: Services Under Arrangements 38 G147 - G149 484.14(i) Standard: Institutional Planning 39 G150 484.14(j) Standard: Laboratory Services 41 G151 - G153 484.16 Condition of Participation: Group of Professional Personnel 43 G154 - G155 484.16(a) Standard: Advisory and Evaluation Function 43 G156 - G158 484.18 Condition of Participation: Acceptance of Patients, Plan of Care, Medical 43 Supervision G159 - G162 484.18(a) Standard: Plan of Care 44 G163 - G164 484.18(b) Standard: Periodic Review of Plan of Care 47
G165 - G166, G167 (Expired) AND G300 484.18(c) Standard: Conformance with Physician s Orders 48 G320 484.20 Condition of Participation: Reporting OASIS Information 49 G321 484.20(a) Standard: Encoding OASIS Data 50 G322 484.20(b) Standard: Accuracy of Encoded OASIS Data 51 G326-327, G328 484.20(c) Standard: Transmittal of OASIS Data 52 G327 484.20(d) Standard: Data Format 56 SUBPART C - FURNISHING OF SERVICES 57 G168 - G170 484.30 Condition of Participation: Skilled Nursing Services 57 G171 - G178 484.30(a) Standard: Duties of the Registered Nurse 57 G179 - G183 484.30(b) Standard: Duties of the Licensed Practical Nurse 59 G184 - G189 484.32 Condition of Participation: Therapy Services 59 G190 - G192 484.32(a) Standard: Supervision of Physical Therapy Assistant and Occupational 61 Therapy Assistant G193 484.32(b) Standard: Supervision of Speech Therapy Services 62 G194 - G201 484.34 Condition of Participation: Medical Social Services 62 G202 - G203 484.36 Condition of Participation: Home Health Aide Services 62 G204 - G210 484.36(a) Standard: Home Health Aide Training 63 G211 - G222 484.36(b) Standard: Competency Evaluation and In-service Training 67 G223 - G227 484.36(c) Standard: Assignment and Duties of the Home Health Aide 70 G228 - G232 484.36(d) Standard: Supervision 71
And G301 - G302 G233 484.36(e) Standard: Personal Care Attendant: Evaluation Requirements 73 G234 484.38 Condition of Participation: Qualifying to Furnish Outpatient Physical Therapy 73 or Speech Pathology Services G235 - G236 484.48 Condition of Participation: Clinical Records 74 And G303 G237 - G238 484.48(a) Standard: Retention of Records 77 G239 - G241 484.48(b) Standard: Protection of Records 78 G242 - G247 484.52 Condition of Participation: Evaluation of the Agency s Program 78 G248 - G249 484.52(a) Standard: Policy and Administrative Review 79 G250 - G251 484.52(b) Standard: Clinical Record Review 80 G330 484.55 Condition of Participation: Comprehensive Assessment of Patients 81 G331 - G333 484.55(a) Standard: Initial Assessment Visit 84 G334 - G336 484.55(b) Standard: Completion of the Comprehensive Assessment 88 G337 484.55(c) Standard: Drug Regimen Review 91 G338 - G341 484.55(d) Standard: Update of the Comprehensive Assessment 93 G 342 484.55(e) Standard: Incorporation of OASIS Data Items 97 APPENDIX 1 SURVEY PROTOCOLS Home Health Agency (HHA) Survey Protocols 1-12 HHA Survey Investigation Worksheet 1 HHA Survey Investigation Worksheet 2 HHA Survey Investigation Calendar