Prohealth Home Health-Dfw

“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 record review and interview, the Agency failed to encode and electronically transmit each completed OASIS assessment to the CMS system, within 30 days of completing the assessment of the patient for 33 of 1448 assessments processed for the time reviewed of 06/01/2024 to 12/31/2024. This failure resulted in quality data used to continuously improve the effectiveness of home healthcare failing to be reported to CMS in the required time frame. The findings included: The HHA Error Summary Report, retrieved from the iQIES website for the time of 06/01/2024 to 12/31/2024 was reviewed. Review of the HHA Error Summary Report for the time-period 06/01/2024 to 12/31/2024 identified Error #-3330. The description for Error #-3330 read in part, “Record Submitted Late: The submission date is more than 30 days after M0090 (Item M0090 specifies the date the actual assessment was completed) on this new record.” The documentation further identified the number of assessments with the error was 33 assessments and the percentage of assessments with this error was 2.28% of the total of 1448 assessments completed by the Agency. A joint interview was conducted with the Alternate Administrator and the Administrator on 8/15/2025 at 2:00 p.m. The HHA Error Summary Report was reviewed with the Alternate Administrator. The Alternate Administrator stated the Agency both acknowledged the responsibility of the late submission. The Alternate Administrator also stated that the issue was with two former employees chronically submitting the OASIS assessments late to which they no longer work at the agency as of 1/2025. During a record review of an Agency policy titled, “Timelines,” dated for revision 7/1/2025, read in part, “…All completed and encoded OASIS data will be transmitted via electronic communication software that is available from CMS … It will be transmitted using electronic communications software…from the Agency or the Agency contractor to the CMS collection site within 30 days of the M0090 date…””

“Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This Element is not met as evidenced by: Based on record review and interviews, the agency failed to administer proper written notice to 1 of 5 (Patient #12) discharged patients, in advance of the HHA termination on-going care in that: 1) The agency failed to administer Home Health Change of Care Notification to Patient #12 prior to Patient #12’s discharge. This failure could place the agency’s patients at risk due to inadequate continuation of care and patient preparation prior to patient discharge. The findings included: During the entrance conference on 8/8/2025 at 1:30 p.m., with the Administrator in person. With further discussion, the agency’s administrative staff were notified that a recertification and relicensure survey would be conducted, and that discharged patients will be reviewed. The surveyor requested 5 discharged patient records for review. During a record review of Patient #12 clinical records, the clinical records revealed a start of care date of 4/6/2023 with a diagnosis of chronic wounds due to leg swelling and with a certification date of 6/5/2023 to 8/3/2023. Patient #12 was receiving skilled nursing visits three times weekly. Further review of clinical records written by the Alternate Administrator, reveal Patient #12 was discharged on 6/28/2023 due to Patient #12 being transferred to another agency . Further record review revealed no evidence of the Home Health Change of Care Notification was given to Patient #12 prior to transfer. During an interview on 8/15/2025 at 3:30 p.m., with the Alternate Administrator, the Alternate Administrator was informed of the findings and acknowledged responsibility and stated that the notice could have been mailed to the Patient #12’s residence. The Alternate Administrator stated that at the time she didn’t think the Home Health Change of Care Notification was needed as she made sure Patient #12 was transferred to another agency. The Alternate Administrator also stated that Patient #12 was discharged due to staff safety concerns at the time of discharge. Record review of an agency policy titled, “Advanced Beneficiary/Change of Care Notices,” dated 02/01/2025, read in part, “…3. Termination - If the patient/client, or representative, wants to continue receiving care from the Agency that will not be covered by Medicare for any of the statutory reasons as listed previously and a physician orders the services, an Advanced Beneficiary Notice must be issued to the patient/client, or Representative for the Agency to charge the patient/client or secondary insurer…b. If the termination is due to an agency closure, or other reason that the agency can no longer provide services and the patient may still qualify for services, the [Home Health Change of Care Notification] is provided.””