Home Health170
Every home health provider171 must certify, as appropriate,172 a beneficiary’s need for home health services, and must periodically provide materials for recertification in accordance with regulations.173
Home health agencies must include the individual’s plan of care in the patient’s clinical records.174
Every home health agency must protect and promote the rights of each individual under its care including:175
· The right to be fully informed in advance about the care and treatment to be provided and to participate in planning care and treatment;176
· The right to voice grievances with respect to treatment or care that is or fails to be furnished, without discrimination or reprisal for voicing grievances;177 and
· The right to confidentiality of clinical records.178
Every three years,179 each home health agency will be subject to a standard survey.180 Within two months of receiving a significant number of complaints about the agency, a standard survey will be conducted.181 A standard survey will include:
· Visits to the homes of a sample of individuals to evaluate whether the furnished items and services attained and maintained the highest practicable functional capacity of the individual as reflected in the written plan of care and clinical records,182 and
· A survey of the quality of furnished care and services as measured by indicators of medical, nursing and rehabilitative care.183
If the standard survey indicates that the agency has provided a substandard quality of care, the agency will be immediately subject to an extended survey to review and identify the policies and procedures which produced such substandard care and to determine whether the agency has complied with the conditions of participation.184
Footnotes
- 170. Social Security Act §1814, 42 U.S.C. 1395f ; Social Security Act § 1861, 42 U.S.C. 1395x; Social Security Act § 1891, 42 U.S.C. 1395bbb; Social Security Act § 1895, 42 U.S.C. 1395fff .
- 171. Provider = a physician, or for (B) services, a physician, an NP, a clinical nurse specialist or a PA who does not have a direct/indirect employment relationship with the facility but is working in collaboration with a physician
- 172. Social Security Act § 1814(a), 42 U.S.C. 1395f(a).
- 173. Social Security Act § 1814(a), 42 U.S.C. 1395f(a).
- 174. Social Security Act § 1861(o)(3), 42 U.S.C. 1395bbb(a)(1).
- 175. Social Security Act § 1891(a)(1), 42 U.S.C. 1395bbb(a)(1).
- 176. Social Security Act § 1891(a)(1)(A), 42 U.S.C. 1395bbb(a)(1)(A).
- 177. Social Security Act § 1891(a)(1)(B), 42 U.S.C. 1395bbb(a)(1)(B).
- 178. Social Security Act § 1891(a)(1)(C), 42 U.S.C. 1395bbb(a)(1)(C).
- 179. Social Security Act § 1891(c)(2)(A), 42 U.S.C. 1395bbb(c)(2)(A).
- 180. Social Security Act § 1891(c)(1), 42 U.S.C. 1395bbb(c)(1).
- 181. Social Security Act § 1891(c)(2)(B)(ii), 42 U.S.C. 1395bbb(c)(2)(B)(ii).
- 182. Social Security Act § 1891(c)(2)(C)(i)(I), 42 U.S.C. 1395bbb(c)(2)(C)(i)(I).
- 183. Social Security Act § 1891(c)(2)(C)(i)(II), 42 U.S.C. 1395bbb(c)(2)(C)(i)(II).
- 184. Social Security Act § 1891(c)(2)(D), 42 U.S.C. 1395bbb(c)(2)(D).
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