Eclipse Home Health Services Inc.

“Written notice of patient’s rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient’s rights and responsibilities under this rule, and the HHA’s transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This Element is not met as evidenced by: Based on observation, record reviews and interviews, the agency failed to provide written notice of the agency’s transfer and discharge policies for 3 (Patients #1, 3 and 5) of 3 patients who received a home visit from the Surveyor. This failure did not conform to the patients’ right to be provided with information regarding the criteria used to determine if the patient could be discharged or transferred from agency services. The failure potentially placed the patients at risk of inadequate plans for continued healthcare and services after discharge from the agency. FINDINGS INCLUDE: Patient #1: Review of the record revealed a POC dated 03/31/2026 to 05/29/2026 with a SOC date 03/31/2026. During a home visit and interview on 05/20/2026 at 11:15 AM, the Surveyor reviewed the patients’ home folder (dark blue paper folder) provided by the agency. The Surveyor asked the patient if anything was missing from the folder or had been removed. Patient #1 stated he did not believe anything had been removed. He stated AA/ADON was his nurse who took care of the folder and wrote on a log when he visited. Review of the patient’s home folder revealed no evidence the agency’s transfer/discharge policy had been provided to the patient. Patient #3: Review of the record revealed a POC dated 03/13/2026 to 05/11/2026 with a SOC date 09/19/2024. During a home visit and interview on 05/20/2026 at 10:10 AM, the Surveyor reviewed the patients’ home folder (dark blue paper folder) provided by the agency. The Surveyor asked the patient and the patient’s family member if anything was missing from the folder or had been removed. The patient’s family member stated he did not think anything had been removed. Review of the patient’s home folder revealed no evidence the agency’s transfer/discharge policy had been provided to the patient. Patient #5: Review of the record revealed a POC dated04/20/2026 to 06/18/2026 with a SOC date 04/20/2026. During a home visit and interview on 05/20/2026 at 1:40 PM, the Surveyor reviewed the patients’ home folder (dark blue paper folder) provided by the agency. The Surveyor asked the patient if anything was missing from the folder or had been removed. Patient #5 stated he was new with the agency, the folder was new and everything was still in the folder that the nurse had brought to him when he started. Review of the patient’s home folder revealed no evidence the agency’s transfer/discharge policy had been provided to the patient. Review of the sample home folder provided by the Administrator/DON on 05/22/26 at 10:00 AM revealed no agency policy on Transfer and Discharge policy included. During an interview with the Administrator/DON and AA/ADON on 05/22/2026 at 12:30 PM, the Surveyor reviewed the findings and asked why the agency did not provide written notice of the agency’s transfer and discharge policy. The Administrator/DON reviewed the agency’s sample home folder with the surveyor and stated, “the policy is not in here.” The Surveyor stated the policy was not found in Patient #1, #3 and #5’s homes during the home visits. The Administrator/DON and AA/ADON stated they were not aware of the change from CMS that required the agency to provide the policy to the patient and no one had mentioned it to them before.”

“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 interview, the agency failed to ensure proper written notice was provided, in advance of terminating on-going care in 2 (Patients #6 and #7) of 2 inactive patient records reviewed who required a written notice. The agency failed to provide the patients with the correct QIO (independent reviewer authorized by Medicare to review the decision to end home health services) phone number to appeal the discharge decision. This failure potentially placed the patients’ health and safety at risk and could result in physical or emotional harm due to lack of consistency or continuing care in the patients’ post discharge needs. The failure caused the patients to not have written advance notice to appeal the discharge decision. Findings include: A discharge list provided by the Administrator/DON on 05/18/2026 at 11:20 AM, included the reason for discharge, “Goals met” for Patients #6 and #7. Patient #6: Review of the record revealed a POC for the certification period 04/11/2025 to 06/09/2025 with a SOC date 12/26/2025. The record included a CMS form titled, “Notice of Medicare Non-Coverage (NOMNC)” dated 06/05/2025 and signed by Patient #6. On page one, the form included, “… Call your QIO at {insert QIO name and toll-free number of QIO} to appeal, or if you have questions. …” The agency did not provided the correct QIO phone number for the patient to request an immediate appeal of the discharge decision. Patient #7: Review of the record revealed a POC for the certification period 11/16/2025 to 01/14/2026 with a SOC date 09/17/2025. The record included a CMS form titled, “Notice of Medicare Non-Coverage (NOMNC)” dated 01/09/2026 and signed by Patient #7. On page one, the form included, “… Call your QIO (Identifier C) at (toll-free number, Identifier D) to appeal, or if you have questions. …” The agency did not provided the correct QIO phone number for the patient to request an immediate appeal of the discharge decision. During an interview with the Administrator/DON and the AA/ADON on 05/22/2026 at 12:30 PM, the surveyor asked who was responsible for ensuring that the agency provided written notice of the intent to discharge with the NOMNC form no later than two days in advance of terminating on-going care for Patients # 6 and 7. The Administrator/DON stated that she and the AA/ADON would be responsible, depending on who made the last home visit at the time of discharge. The surveyor asked what the agency process was for discharging patients. The Administrator/DON stated they made sure that the discharge notice was explained and the written notice was given to the patients. The surveyor reviewed the findings and asked why the notices did not include the current QIO toll free phone number for the patients to appeal the discharge decision. The Administrator/DON stated they were not aware the QIO and phone number had changed. Agency policy, revised date 12/01/2006, quoted in part, “PATIENT DISCHARGE, … PURPOSE: To assess each patient’s discharge planning and/or continuing care needs prior to discharge from Agency. … To provide the patients in Original Medicare access to an expedited determination process when their Medicare covered Home Health Agency services are ending. To allow patients to challenge/appeal their provider’s decision to discharge. Policy: … Agency will provide appropriate discharge planning and notification, per regulations. … Termination Notice and Expedited Review: Agency staff will provide valid delivery notice (involves both delivery and completion) of the generic notice to the beneficiary when the end of all covered care is foreseen, even if the beneficiary agrees with the discharge. …””

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on observations, record reviews and interviews, the agency failed to provide the patient and caregiver with written information outlining a visit schedule including frequency of visits by home health staff and personnel acting on behalf of the agency, in 3 (Patients #1, 3 and 5) of 3 patients who received a home visit from the Surveyor. This failure potentially placed the patients at risk of missed visits by staff when visits were not scheduled and conflicted with other appointments and the availability of the patients. FINDINGS INCLUDE: Patient #1: Review of the record revealed a POC dated 03/31/2026 to 05/29/2026 with a SOC date 03/31/2026. The POC listed physician orders for the SN visit frequency: no visit the 1st week, twice a week for four weeks, then no visit for one week. Review of the record revealed no evidence a visit schedule had been provided to Patient #1. During a home visit and interview on 05/20/2026 at 11:15 AM, the Surveyor reviewed the patients’ home folder (dark blue paper folder) provided by the agency. Patient #1 lived in a group home and the Surveyor asked Patient #1 if there was a caregiver to assist him. Patient #1 stated the group home employee assisted with ADL’s daily, but he alone was responsible for keeping up with his business and papers. The Surveyor asked Patient #1 if anything was missing from the folder or had been removed. Patient #1 stated he did not believe anything had been removed. He stated AA/ADON took care of the folder and wrote on a log when he visited. The Surveyor asked Patient #1 if a SN visited twice a week or every two weeks. Patient #1 stated RN A visited every 2 weeks to administer an injection that was prescribed for every two weeks. Review of the patient’s home folder revealed no visit schedule had been provided to the patient. The Surveyor asked Patient #1 if he had received a written visit schedule for SN visits from the agency. Patient #1 stated he didn’t receive a visit schedule in writing, but RN A usually visited on Thursdays due to the “busy schedule” with attendant services twice a week, doctor appointments and the radiation treatments every two days now. Patient #3: Review of the record revealed a POC dated 03/13/2026 to 05/11/2026 with a SOC date 09/19/2024. During a home visit and interview on 05/20/2026 at 10:10 AM, the Surveyor was greeted by Patient #3’s family member who attended and assisted with the interview due to the patient’s hearing deficit. The family member stated he assisted Patient #3 during the day and other family members assisted the patient at night. The Surveyor reviewed the patients’ home folder (dark blue paper folder) provided by the agency. The Surveyor asked the patient and the patient’s family member if anything was missing from the folder or had been removed. The patient’s family member stated he did not think anything had been removed. Review of the patient’s home folder revealed no evidence the agency’s transfer/discharge policy had been provided to the patient. Review of the patient’s home folder revealed no evidence a visit schedule had been provided to the patient. Patient #5: Review of the record revealed a POC dated 04/20/2026 to 06/18/2026 with a SOC date 04/20/2026. During a home visit and interview on 05/20/2026 at 1:40 PM, the Surveyor reviewed the patients’ home folder (dark blue paper folder) provided by the agency and asked if a caregiver or anyone assisted the patient with taking care of his home health paperwork. Patient #5 stated he lived with family members, but that he was the one who kept up with his medical paperwork. The Surveyor asked the patient if anything was missing from the folder or had been removed. Patient #5 stated he was new with the agency, the folder was new and everything was still in the folder that the nurse had brought to him when he started. Review of the patient’s home folder revealed no evidence a visit schedule had been provided to the patient. Review of the sample home folder provided by the Administrator/DON on 05/22/26 at 10:00 AM revealed no sample visit schedule. In an interview with the Administrator/DON and AA/ADON on 05/22/2026 at approximately 12:30 PM, the surveyor reviewed the findings and asked why the patients did not have written visit schedules to include frequency of visits provided by the agency. The Administrator/DON stated she was not aware of the new regulation. The Surveyor asked who in the agency was responsible to ensure all notices and information was provided to the patients. The Administrator/DON stated she was the one who made sure the skilled patients received everything.”