Home Town Health Care

“Reporting OASIS information CFR(s): 484.45 Condition of participation: HHAs must electronically report all OASIS data collected in accordance with §484.55. This Condition is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure they transmitted completed OASIS assessment data to the CMS system for all Medicare/Medicaid patients within 30 days of completing the assessments and failed to encode and transmit the data using software that conformed to requirements. Findings Include: 1.The agency failed to ensure they transmitted a completed OASIS assessment to the CMS system for all Medicare/Medicaid patients within 30 days of completing the assessment. (Refer to G372) 2. The agency failed to ensure they transmitted OASIS data to CMS using appropriate software that conforms to CMS requirements. (Refer to G386)”

“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 document review and staff interview, the agency failed to ensure they transmitted a completed OASIS to the CMS system for all Medicare/Medicaid patients within 30 days of completing the assessments. This failure resulted in the agency’s inability to ensure the provision of quality health care across the health care spectrum. Findings Include: Review of an agency document that confirmed unduplicated admissions of patients for the last twelve months, showed two patients admitted, with one patient currently receiving agency services. Review of clinical records for both patients showed the Comprehensive Assessment had been performed, that included the OASIS assessment. During an interview on 09/04/24 at 1:30 PM, Staff A, Director of Quality Assurance, confirmed the agency had so few admissions due to the inability to transmit OASIS assessments to CMS. Staff A confirmed inability to login to the system.”

“Data Format CFR(s): 484.45(d) Standard: Data Format. The HHA must encode and transmit data using the software available from CMS or software that conforms to CMS standard electronic record layout, edit specifications, and data dictionary, and that includes the required OASIS data set. This Standard is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure they transmitted OASIS data to CMS using appropriate software requirements and timelines. This failure resulted in the agency’s inability to ensure the provision of quality health care across the health care spectrum. Findings Include: Review of an agency document that confirmed unduplicated admissions of patients for the last twelve months, showed two patients admitted, with one patient currently receiving agency services. Review of clinical records for both patients showed the Comprehensive Assessment had been performed, that included the OASIS assessment. During an interview on 09/04/24 at 1:30 PM, Staff A, Director of Quality Assurance, confirmed the agency had so few admissions due to the inability to transmit OASIS assessments to CMS. Staff A confirmed inability to login to the system.”

“Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This Element is not met as evidenced by: Based on document review, record review and staff interview, the Home Health Agency (HHA) failed to inform the patients verbally or in writing regarding any payment for services expected from insurance providers, charges for services that might not be covered by insurance providers, or the charges the patient might have to pay for 2 (Patients 1 and 2) of 2 Patients reviewed. The Home Health Agency’s failure to ensure the patient’s right to be informed regarding payment, placed all patients currently on service, at risk for unmet needs, care and services. Findings Include: Review of the consent forms for both Patient 1 and Patient 2 showed the documents lacked written information regarding any payment for services. Review of the clinical record for both Patient 1 and Patient 2 showed the records lacked documentation that confirmed the patients had been informed regarding payment information. During an interview on 09/05/24 at 2:15 PM, Staff A (Director of Quality Assurance) and Staff B (Chief Operations Officer) stated that the agency did not plan to charge the patients for uncovered services and that they were not aware of the need to inform the patient regarding Medicare payments.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on record review and staff interview, the Home Health Agency (HHA) failed to conduct an initial assessment visit within 48 hours after receiving a referral to provide services for 1 (Patient 2) of 2 patients reviewed. This failure had the potential for the patients to not receive needed assessments and home care services and could have negatively impacted outcomes. Findings Include: Patient 2 Review of Patient 2’s, “Home Health Certification and Plan of Care (POC),”dated 11/08/22, showed that the patient was admitted with a primary diagnosis of encounter for aftercare following surgery of the circulatory system with orders for Skilled Nursing and Physical Therapy. Review of faxed referral information indicated the date of receival to be 11/04/22. There was no documented evidence to show why there was a delay in the Start of Care (SOC) or that the referring physician was notified of the delayed SOC. During an interview on 09/05/24 at 2:30 PM, Staff A, Director of Quality Assurance, confirmed that the agency had not admitted the patient within the 48-hour time frame, nor was the physician made aware of the delay in starting services.”

“Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This Element is not met as evidenced by: Based on document review, record review, and staff interview, the Home Health Agency (HHA) failed to provide the patient and caregiver a copy of written instructions outlining how and when to contact the HHA’s clinical manager for 2 (Patients 1 and 2) of 2 Patients reviewed. The home health agency’s failure to ensure that the patients received written information regarding the name and contact information for the clinical manger placed all patients currently on services at risk for unmet needs, care and services. Findings Include: Review of the admission packet provided by the Home Health Agency (HHA), showed the agency documents lacked information regarding the name and phone number for the agency’s clinical manager. During a home visit with Patient 1, on 09/05/24 at 11:00 AM, the surveyor reviewed all paperwork in the home, provided by the agency. There was no contact information for the clinical manager found with the documents. Review of Patient 1’s clinical record, showed the record lacked evidence of documentation that explained how to contact the clinical manager if needed. During an interview on 09/05/24 at 2:00 PM, Staff B, Chief Operations Officer, stated that the information for the clinical manager had mistakenly been left out of the admission packet.”