Transcript OASIS Updates HCAW Annual Conference April 17th, 2015

State Licensing, Survey, and OASIS
Updates
Jada Lynn, BSN, RN
John Hilger, MSW
Jane Hawk, DNP, RN
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/ind
ex.html?redirect=/icd10
• Sign up for ICD-10 Email Updates:
http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD10_Industry_Email_Updates.html
• ICD-10 Resources Flyer:
http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Resour
cesFlyer20141105.pdf
http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
• IDC-10 Fact Sheet:
http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introd
uction20140819.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
• [email protected]
• 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 Citations
State 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
Most Frequent Citations
State Home Care
45
40
35
30
25
20
15
10
5
0
Supervision of Home
Care Care
Supervision
of Home
*Reporting
of Abuse/Neglect
*Reporting
of
Abuse/Neglect
*Annual Performance
Reviews
*Annual
Performance
Reviews
*Verification of Skills
*Verification of Skills
Most Frequent Citations
State 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
Most Frequent Citations
State Home Health
45
40
35
30
25
20
15
10
5
0
*Reporting
of Abuse/Neglect
*Reporting
of
Abuse/Neglect
*Annual *Annual
Performance Reviews
Performance Reviews
*Verification of Skills
*Verification of
Skills
*Evidence
of Disclosure
Statement
*Evidence
of Disclosure
Statement
Most Frequent Citations
State 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 Citations
State Hospice
8
7
6
5
4
3
2
1
0
Bill of
of Rights
Bill
Rights
Consent
for Service
Consent
for
Hospice
PlanPlan
of Care
Hospice
of
Service
Care
Hospice Plan
of Care
Hospice
Plan
of
Care
Medicare Surveys
• Survey Data per Calendar Year
January 1, 2014 thru December 31, 2014
• Medicare surveys for Home Health: 43
• Medicare survey for Hospice: 5
Most Frequent Citations
Medicare Home Health
8
7
6
5
4
3
2
1
0
Care Follow Written Plan of Care: G 158Supervisory
Supervisory Visits
Every Every
2 Weeks:two
G 229
Visits
Care Follow Written
Plan of Care: G 158
Weeks: G 229
Initial
Assessment
Within 48
Hrs. of
Initial
Assessment
w/in
Referral: G 332
48 Hrs of Referral: G 332
Comply With Professional Standards &
Comply
With Professional
Principles: G 121
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 Year
January 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?