State Licensing, Survey, and OASIS Updates

Jada Lynn, BSN, RN Jane Hawk, DNP, RN

John Hilger, MSW Patricia Terry, MPA, RN

In-Home Services (IHS) Program

• The IHS program is organized into two key areas:• Licensing, rules, and policy (“Program”)• Inspections and complaint investigations

• IHS licensing, rules, and policy is managed by John Hilger

• IHS inspections & investigations is managed by (TBA)

IHS Licensing Update

• The department’s In-Home Services license allows licensees to choose either a single service category or a combination of categories they want to offer:• Home Care• Home Health• Hospice• Hospice Care Center

Licensing Update Continued

• The following licensing numbers were accurate as of March 20, 2015.

• 434 “active” In-Home Services licenses

• 25 “pending” In-Home Services licenses

Licensing Update Continued

• Service Category Breakdown:• 255 Home Care Agencies• 207 Home Health Agencies• 35 Hospice Agencies• 9 Hospice Care Centers

• These category numbers won’t add up to the 434 licenses because one agency can have multiple service categories.

Licensing Update Continued

Number of Medicare Certified agencies:

• 64 Medicare Certified Home Health Agencies• 31 Medicare Certified Hospice Agencies• 9 Medicare Certified Hospice Care Centers

• 70 DSHS contracted Home Care Agencies

Investigations Update

State investigations data for 2014 calendar year

• 80 State Investigations • The majority of complaints involve home care

agencies• 62 out of 80 complaints involved allegations of

poor standards of care• 8 out of the 80 complaints were allegations of

unlicensed agencies

Survey Team

The department has five dedicated In-Home Services surveyors:

• Jada Lynn, BSN, RN• Lori Barney, MN, RN• Patricia Terry, MPA, RN• Sarah Benson, BSN, RN• Suzanne Kinchen, BSN, MPH, RN

OASIS Updates

Outreach Education• Webinars

• Non-Pressure Ulcer skin M-items• Wednesday, May 20 @ 10-11am• Wednesday, May 27 @ 1p-2p [Encore presentation]

• Invites sent via email last month• OASIS Version C1/ICD-10

• Wednesday, September 16 @ 10-11am• Wednesday, September 23 @ 1p-2p [Encore presentation]

• Invitations will be emailed in August• OASIS Test Your Knowledge Q&As

• 2 Q&As sent via email in Feb, May, August & November• OASIS FAQs

• Read OASIS Q&As from WA providers; next issue: April• OASIS Bulletins

• Spring, Summer, Fall

ICD-10

• New CMS web site info on ICD-10: http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10

• Sign up for ICD-10 Email Updates: http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email_Updates.html

• ICD-10 Resources Flyer: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ResourcesFlyer20141105.pdf

http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

• IDC-10 Fact Sheet: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introduction20140819.pdf

ASAP Updates

• QTSO Memos• 2015-004:

• OASIS Assessment Submission and Processing (ASAP) System Enhancements• Enhancements to correct the editing of M0016 Branch ID Number

field

• 2015-007: • OASIS records Rejected Due to Error -4700 or -4710

• Addresses inconsistencies between the Branch ID data in the state database and the Branch ID in national database

• 2015-016: • OASIS ASAP Error – 4820

• Invalid HIPSS code• Warning message; record will be accepted• Enhancement for this error will occur with Oct. 1 update

Resources

• OASIS Submission User’s Guide• OASIS Quarterly Q&As• Home Health Care Agency Systems User’s Guide• https://www.qtso.com/hhatrain.html

• Error Messages• https://www.qtso.com/download/Guides/hha/user/Users_sec5_14.pdf

• QIES Help Desk• Help@QTSO.com• 800-339-9313

Survey Updates

State Inspections

• Surveys Data per Calendar Year January 1, 2014 thru December 31, 2014

• Agencies surveyed in calendar year for all categories of In-Home Licensing: 271

Most Frequent CitationsState Home Care

• WAC 246-335-105 Supervision of home care (41)• Z 2080• Every 6 months• To assess client satisfaction• To assess aide compliance with the plan of care

• WAC 246-335-060 Delivery of Care (40)• Z 0720 Reporting of abuse/neglect

• WAC 246-335-070 Personnel Records (40)• Z 0970 Annual performance evaluations

• WAC 246-335-070 Personnel Records (31)• Z 0920 Verification of skills

Supervision of Home Care *Reporting of Abuse/Neglect *Annual Performance Reviews *Verification of Skills0

5

10

15

20

25

30

35

40

45

Most Frequent CitationsState Home Care

Supervision of Home Care *Reporting of Abuse/Neglect

*Annual PerformanceReviews

*Verification of Skills

Most Frequent CitationsState Home Health

• WAC 246-335 060 Delivery of Services (40)• Z 0720 Reporting of Abuse and Neglect

• WAC 246-335-070 Personnel Records (40)• Z 0970 Annual evaluations

• WAC 246-335-070 Personnel Records (31)• Z 0920 Verification of skills

• WAC 246-335-070 Personnel Records (25)• Z 0930 Evidence of disclosure checklist and criminal background

checks

*Reporting of Abuse/Neglect *Annual Performance Reviews *Verification of Skills *Evidence of Disclosure Statement0

5

10

15

20

25

30

35

40

45

Most Frequent CitationsState Home Health

*Reporting of Abuse/Neglect

*Annual Performance Reviews

*Verification of Skills

*Evidence of Disclosure Statement

Most Frequent CitationsState Hospice

• WAC 246-335-075 Bill of Rights (7)• Z 1120 Bill of Rights are implemented and updated

• WAC 246-335-110(1)(c )(ii) Patient/client records (5)• Z 2190 Consent for service, care, and treatment

• WAC 246-335-085 (1)(c )(ii), (vii) Hospice Plan of Care • Z 1490 Include goals and outcome measures on Plan of

Care (4)• Z 1540 Include special nutritional needs and food allergies

(1)

Most Frequent CitationsState Hospice

Bill of Rights Consent for Service Hospice Plan of Care Hospice Plan of Care0

1

2

3

4

5

6

7

8

Bill of Rights Consent for Service

Hospice Plan of Care

Hospice Plan of Care

Medicare Surveys

• Survey Data per Calendar YearJanuary 1, 2014 thru December 31, 2014

• Medicare surveys for Home Health: 43 • Medicare survey for Hospice: 5

Care Follow Written Plan of Care: G 158

Supervisory Visits Every 2 Weeks: G 229

Initial Assessment Within 48 Hrs. of Referral: G 332

Comply With Professional Standards & Principles: G 121

0

1

2

3

4

5

6

7

8

Most Frequent CitationsMedicare Home Health

Care Follow Written Plan of Care: G 158

Supervisory Visits Every two Weeks: G 229

Initial Assessment w/in 48 Hrs of Referral: G 332

Comply With Professional Standards & Principles: G 121

Most Frequent Citations Medicare Home Health

• 484.18 Condition of Participation: Acceptance of Patients, Plan of Care, and Medical Supervision

• G 158 (Level One citation) (7)• “Care follows a written plan of care established and

periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.”

• This citation is specific to ‘missed visits’ as

referenced in the Interpretive Guidelines.

Most Frequent Citations Medicare Home Health

• 484.36 Condition of Participation: Home Health aide services.

• G 229 (Level One citation) (6)• “The registered nurse (or another professional

described in paragraph (d)L(1) of this section) must make an on-site visit to the patient’s home no less frequently than every 2 weeks.”

Most Frequent Citations Medicare Home Health

• 484.55 Condition of Participation: Comprehensive assessment of patients

• G 332 (Level One citation) (6)• Initial assessment within 48 hours of referral or 48

hours of patient’s return home, or on the physician-ordered start-of-care date.

Most Frequent Citations Medicare Home Health

• 484.11 Condition of Participation: Compliance with Federal, State and local laws, disclosure, ownership information, accepted professional standards and principles.

• G 121 (Level One citation) (4)• The HHA and its staff must comply with accepted

professional standards and principles that apply to professionals furnishing services in an HHA• Reporting of Abuse and Neglect (1)• Criminal background checks and Disclosure checklist (1)• Infection control practices (2)

Medicare Hospice Surveys

• Survey Data per Calendar YearJanuary 1, 2014 – December 31, 2014

• 418.54 CoP: Initial and comprehensive assessment• L 521 “The hospice must conduct and document in writing

a patient-specific comprehensive assessment”

• 418. 56 CoP: Interdisciplinary group, care planning and coordination of services• L 543 (Standard) “All care/services follow individualized

plan of care”

Medicare Hospice Surveys

• 418. CoP: hospice aide and homemaker services• L 629 (Standard) RN on-site visit (i) every 14 days/aide

presence not required

• 418.78 CoP: Volunteers• L 645 (Standard) Recruiting and retaining of

volunteers• L 646 Cost savings by using volunteers• L 947( Standard) Volunteer activity equals 5% of total

patient care hour

Medicare Hospice Surveys

• 418.108 CoP: Short-term patient care• L 715 Hospice responsible for training personnel

• 418.110 CoP: Hospices that provide inpatient care directly• L 737 (Standard) Right to be free from physical and mental

abuse/restraint/seclusion

• 418.112 CoP: Hospices that provide hospice care to resident of a SNF/NF or ICF/MR (facility)• L 771 Report alleged violations/unrelated to hospice/in 24

hours

Medicare Hospice Surveys

• 418.114 CoP: Personnel qualifications• L 796 (Standard) Criminal background checks in

accordance with State law/3 months from employment

• 418.116 CoP: Compliance with Federal/State/local laws• L 798 Operate in compliance with above laws

Questions?