Amedisys Home Health

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on the Centers for Medicare & Medicaid Services (CMS) Home Health Agency (HHA) Error Summary by Agency Report, review of policy “Oasis Outcome and Information Set,” and staff interview, it was determined that the agency failed to electronically transmit Outcome and Assessment Information Set (OASIS) data to CMS within 30 days of completing the assessment. Findings include: Review of the policy titled “Oasis Outcome and Information Set,” number AA-006, reviewed 9/26/2024, revealed the following: 10. OASIS data will be accurate, completed, encoded and routinely transmitted to CMS in accordance with required submission timelines. Review of CMS report titled “HHA Error Summary by Agency,” dated 11/13/2024, revealed the agency failed to transmit OASIS data to CMS system within 30 days. On 12/09/2024 at approximately 9:00 am, an interview with the Area Vice President of Clinical Services (AVPCS) revealed the corporate office does OASIS submissions. A plan was recently implemented by the agency to address late submissions, including daily OASIS submissions and review of available reports.”

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on record review, staff interviews, and review of agency’s policy “Plan of Care (POC)/Care Planning Process,” it was determined the agency failed to include interventions for a diagnosis of congestive heart failure (a long-term condition that happens when your heart cannot pump blood well enough to give your body a normal supply) to monitor fluids, edema, weight, or to measure calf, for one patient (P) (P#5) of 17 sampled patients and failed to perform blood sugar for two patients (P#1, P#2) with a diagnosis of type 2 diabetes (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel). The findings include: Review of the Policy tilted “Plan of Care (POC)/Care Planning Process,” revised 11/4/24, reveals the following: Plan of Treatment. An individual plan of treatment shall be developed for each patient in consultation with agency staff and shall cover all pertinent diagnosis and other appropriate items. 6. The individualized plan of must include the following: o. Patient-specific interventions and education: measurable outcomes and goals identified by the HHA and the patient. 1. Review of the POC for P#5 (certification period (start of care) of 11/18/2024 to 1/16/2025) revealed P#5 was admitted to the Home Health agency on 11/18/2024, with a diagnosis of congestive heart failure. The agency failed to address interventions on the POC to monitor fluids retentions, weight, or calf measurements with a diagnosis of congestive heart failure. During an interview on phone with Registered Nurse (RN) DD on 12/10/2024 at 1:29 p.m., RN DD confirmed that the agency failed to address intervention on diagnosis of congestive heart failure on the POC for P#5. On 12/10/2024 at 2:00 p.m. an interview conducted with the Executive Director (ED), who acknowledged that RN DD failed to include intervention for the diagnosis of congestive heart failure for P#5. 2. Review of the POC for P#1 (certification period (start of care) of 11/8/2024 to 1/6/2025) revealed P#1 was admitted to the Home Health agency on 9/9/2024, with a diagnosis of type 2 diabetes. The agency failed to follow POC by performing and documenting blood sugar, as ordered by physician for P#1. Review of the POC for P#2 (certification period (start of care) of 5/20/2021 to 7/18/2021) revealed P#2 was admitted to the Home Health agency on 5/20/2021, with a diagnosis of type 2 diabetes. The agency failed to follow POC by performing, and documenting, blood sugar as ordered by physician for P#2. On 12/10/2024 at 2:32 p.m., an interview was conducted with Licensed Practical Nurse (LPN) AA, who confirmed that the agency failed to perform and document blood sugar as ordered by physician for P#1. On 12/10/2024 at 2:56 p.m., an interview was conducted with Executive Director (ED), who said that Registered Nurse (RN) BB was unavailable for interview. ED also acknowledged that RN BB, and LPN AA, failed to perform and document blood sugar for P#1, and P#2.”

“Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA’s internal policies. (4) When services are provided on the basis of a physician or allowed practitioner’s verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA’s policies, must document the orders in the patient’s clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA’s internal policies. This Element is not met as evidenced by: Based on record review, staff interview, and review of agency’s policy “Plan of Care (POC)/Care Planning Process,” it was determined that the agency failed to have physician sign plan of care (POC), and verbal orders for one patient (P) (P#1) of 17 sampled patients. The findings include: Review of the policy titled “Plan of Care (POC)/Care Planning Process,” revised 11/4/24, reveals that the plan of care will be forwarded to the physician/allowed practitioner for his/her review and should be received with dated signature within thirty (30) days). Review of clinical record for P#1 (certification period dated 11/8/2024 to 1/6/2024), revealed that P#1 was admitted to the home health agency on 9/9/2024. The physician signed the POC on 12/5/2024. The agency physician failed to sign the POC for P#1 within 30 days. On 12/10/2024 at 3:14 p.m., an interview was conducted with the Executive Director (ED) who acknowledged that the physician failed to sign POC and verbal orders, ED additionally explained that it was a struggle for one of their physicians to sign patients’ plan of care in a timely manner, but the company is working to solve the problem.”