Advanced Home Health Services

“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 provide the NOMNC written notice at least two days in advance of terminating on-going care in 3 (Patient #8, #12, & #13) of 5 discharged records reviewed whose reason for discharge was goals met. The failure of the agency to protect the rights of the patient by informing in advance of their right to appeal the discontinuation of home health services prevented the identified patients from exercising their right to appeal the discharge decision if they chose to appeal. Findings include: Patient 8: The record contained a POC dated 3/9/25-5/7/25 with a SOC date of 1/8/25. The record contained a discharge OASIS assessment dated 5/7/25 and signed by RN A. The discharge summary indicated reason for discharge as goals met. The record contained a NOMNC (a Medicare form utilized by health care providers to notify patients of their intent to discontinue services that may no longer be covered by Medicare) signed and dated on 4/3/25 by Patient #8. The agency failed to provide the NOMNC 2 days prior to discharge. An interview was conducted on 6/24/25 at 11:36 am with RN A. The Surveyor reviewed the chart findings for Patient #8 in that no NOMNC was found for Patient #8, discharged on 5/7/25. RN A said, “We discuss the notices in the case conferences.” The surveyor asked did she provide the NOMNC at least 2 days prior to discharge to Patient #8. RN A said, “No, I did not. I was not aware I had to do that.” [AE1] The surveyor asked how not providing the NOMNC at least 2 days prior to discharge would affect the patients. RN A said, “They won’t know they are being discharged or be able to appeal it.” Patient 9: The record contained a POC dated 2/5/25-4/5/25 with a SOC date of 2/5/25. The record contained a discharge OASIS assessment dated 4/3/25 and signed by RN B. The discharge summary indicated reason for discharge as goals met. The record failed to contain a NOMNC. The agency failed to provide the NOMNC 2 days prior to discharge. Surveyor called RN B on 6/24/25 at 10:39 am, 10:53 am, and 11:31 am related to Patient #9. No return call received. Patient 12: The record contained a POC dated 1/22/25-3/22/25 with a SOC date of 1/22/25. The record contained a discharge OASIS assessment dated 3/19/25 and signed by RN C. The discharge summary indicated reason for discharge as goals met. The record failed to contain a NOMNC. The agency failed to provide the NOMNC 2 days prior to discharge. An interview was conducted on 6/24/25 at 11:20 am with RN C. Surveyor reviewed the findings that no 5 day discharge or NOMNC was found in Patient 12’s chart. RN C said, “We talk to them from admission about the plan to discharge.” Surveyor asked if she had provided Patient #12 with the NOMNC. RN C, “I’ve never given a written notice, that is not the process taught by our company.” Surveyor asked RNC how not providing the 5 day discharge written notice and the NOMNC could affect the patient. RN C said, “They wouldn’t know they were being discharged or could not appeal it if they did not get the notice.” Patient 13: The record contained a POC dated 4/14/25-6/12/25 with a SOC date of 4/1425. The record contained a discharge OASIS assessment dated 5/2/25 and signed by PT A. The discharge summary indicated reason for discharge as goals met. The record failed to contain a NOMNC. The agency failed to provide the NOMNC 2 days prior to discharge. An interview was conducted on 6/24/25 at 10:40 am with PT A. Surveyor reviewed with PT A that no NOMNC was found in Patient #13’s chart. Surveyor asked did he have Patient #13 sign the NOMNC. PT A said, “No, I wasn’t sure when she would be discharged.” Surveyor asked how not providing the NOMNC could affect the patients. PT A said, “They wouldn’t be aware they could appeal the discharge and it would affect their patient rights.” An interview was conducted on 6/24/25 at 10:00 am with the Administrator/Supervising Nurse. The surveyor asked Administrator/Supervising Nurse what the agency process was for providing the discharge notices that include the written 5 day discharge notice and the NOMNC. Administrator/Supervising Nurse said, “All new hires are taught in orientation about providing the discharge notices with instructions on completing the forms.” The surveyor reviewed that 3 of 5, Patient 8, Patient #12, and Patient #13 were not provided with the 5 day written discharge notice or the NOMNC. The surveyor reviewed the agency policy, PE.30 Patient/Client transfer and Discharge Notices and PE.30-TX Patient/Client Transfer and discharge Notices – Addendum with Administrator/Supervising Nurse. The Administrator/Supervising Nurse said, “We talk about the discharge notices in case conference a lot, I don’t know why they are not doing them.” The surveyor asked how not providing the discharge notices could affect the patients. Administrator/Supervising Nurse said, “It could affect them negatively, they might need time to set up outpatient therapy and would not know they could appeal the discharge.” Agency policy PE.30 Patient/Client Transfer and Discharge Notices last reviewed 020125 read in part…”Purpose To provide guidance on completion of the required discharge notices. Policy I. Prior to transferring or discharging a patient/client, the Agency will provide written notification to the patient/client or the patient’s/client’s parents, family, spouse, significant other or legal representative….Procedure I. Notice of Medicare Non-Coverage (NOMNC)…A. Agency staff will deliver a completed and valid NOMNC to the patient/client, or representative (if any): 1. When the end of all covered care is foreseen, even if the patient/client agrees with the discharge. 2. At least two (2) calendar days before Medicare covered services end or the second to last day of service if care is not provided daily…R. The Agency will retain a copy of all completed NOMNCs in the patient’s/client’s records”…”