Anyone gone through the new survey process?

youngheartoldhead · Mar 24, 2013

Yes we had ours a couple weeks ago. They made sure all field staff stayed in the FIELD. and when they did come to the office they were told to do what they had to do and go away.......and stay away from state surveyor

paradiseboundRN · Mar 25, 2013

It depends on the size of the agency. I worked for a hospital agency with a census of about 250. In late 2012, the surveyor wanted to see 5 nursing visits which included wound care visits. Of course, she also went out with the other disciplines.

tktjRN · Mar 28, 2013

The surveyors, in Wisconsin, do not go with clinicians anymore to watch visits . A surveyor sees a patient,with one of the managers, for a one on one interview. They make sure the home folder is in order and medications are accurate. They honed in on OTC medications.

youngheartoldhead · Sep 20, 2013

this may help some.

http://www.selectdata.com/the-new-survey-protocols-are-you-ready-or-how-did-you-do/

also you can google: home health care guidelines for surveyors

a few things i can remember are they zero in on medications...(has always been that way)..when they do home visits, the patients meds have to match what is on file at the agency and what is on the patients home care folder. (unless the change occurred since last visit). make sure patient has all info on the meds, side effects, directions and they are taking them correctly.

patient should know who to contact at the agency if they have major problems, how to contact a nurse after hours, the 1-800 number to report abuse. they just need to know these numbers are located in their home folder.

they have to have a basic idea of their privacy rights/ patient rights and that we are billing their insurance for payment....

coordination of care is a big deal . the nurse needs to communicate with all other services the patient is receiving ...physical , occupational therapy, social worker, etc. make entries in the record that you discussed the patient with each other and a basic run down of what u discussed. usually its just getting an update on patient. or discussing any problems.

also if the patient has waiver services from another agency such as a home care attendant, then the agency needs to communicate with them and know what their plan of care is: what they are doing for patient, how often they visit patient..etc....in turn the agency informs them of what aspects of patient care we will be doing (just basic need to know info, such as when we will be changing catheter, who is responsible for calling in regular refills, etc). this is important because both agencies may incorrectly assume that the other taking care of a particular need for the patient and it ends up not being done at all.

turningred15 · Sep 20, 2013

We (in Wisconsin) had surveyors come a couple of weeks ago. Making sure med lists were accurate and up to date, infection control and care coordination were the focus. We were cited several times. (I was not cited though!) We have implemented a corrections plan and are awaiting resurvey. I think it really depends on what person does the survey. Some are much more thorough than others.

LaRN · Sep 21, 2013

this is a guidance for surveyors , which is just the regulations with some pointers to them on how to determine if home health agencies are following them.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf

the entire thing is about 95 pages. there may be a more recent version of this document since the regulations were updated in 2011:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf

State Operations Manual

Appendix B - Guidance to Surveyors: Home Health

Agencies

(Rev. 11, 08-12-05)

Part I – Investigative Procedures

Subpart A - General Provisions

484.1 Basis and Scope

484.2 Definitions

484.4 Personnel Qualifications

Subpart B - Administration

484.10 Condition of Participation: Patient Rights

484.10(a) Standard: Notice of Rights

484.10(b) Standard: Exercise of Rights and Respect for Property and Person

484.10© Standard: Right to be Informed and to Participate in Planning Care and

Treatment

484.10(d) Standard: Confidentiality of Medical Records

484.10(e) Standard: Patient Liability for Payment

484.10(f) Standard: Home Health Hotline

484.11 Condition of Participation: Release of Patient Identifiable OASIS Information

484.12 Condition of Participation: Compliance With Federal, State and Local Laws,

Disclosure and Ownership Information, and Accepted Professional Standards and

Principles

484.12(a) Standard: Compliance With Federal, State, and Local Laws and Regulations

484.12(b) Standard: Disclosure of Ownership and Management Information

484.12© Standard: Compliance With Accepted Professional Standards and Principles

484.14 Condition of Participation: Organization, Services, and Administration

484.14(a) Standard: Services Furnished

484.14(b) Standard: Governing Body

484.14© Standard: Administrator

484.14(d) Standard: Supervising Physician or Registered Nurse

484.14(e) Standard: Personnel Policies 484.14(f) Standard: Personnel Under Hourly or Per Visit Contracts

484.14(g) Standard: Coordination of Patient Services

484.14(h) Standard: Services Under Arrangement

484.14(i) Standard: Institutional Planning

484.14(i)(1) Standard: Annual Operating Budget

484.14(i)(2) Standard: Capital Expenditure Plan

484.14(i)(3) Standard: Preparation of Plan and Budget

484.14(i)(4) Standard: Annual Review of Plan and Budget

484.14(j) Standard: Laboratory Services

484.16 Condition of Participation: Group of Professional Personnel

484.16(a) Standard: Advisory and Evaluation Function

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

Supervision

484.18(a) Standard: Plan of Care

484.18(b) Standard: Periodic Review of Plan of Care

484.18© Standard: Conformance With Physician Orders

484.20 Condition of Participation: Reporting OASIS Information

484.20(a) Standard: Encoding OASIS Data

484.20(b) Standard: Accuracy of Encoded OASIS Data

484.20© Standard: Transmittal of OASIS Data

484.20(d) Standard: Data Format

Subpart C - Furnishing of Services

484.30 Condition of Participation: Skilled Nursing Services

484.30(a) Standard: Duties of the Registered Nurse

484.30(b) Standard: Duties of the Licensed Practical Nurse

484.32 Condition of Participation: Therapy Services

484.32(a) Standard: Supervision of Physical Therapy Assistant and Occupational

Therapy Assistant

484.32(b) Standard: Supervision of Speech Therapy Services

484.34 Condition of Participation: Medical Social Services

484.36 Condition of Participation: Home Health Aide Services

484.36(a) Standard: Home Health Aide Training

484.36(a)(1) Standard: Content and Duration of Training 484.36(a)(2) Standard: Conduct of Training

484.36(a)(3) Standard: Documentation of Training

484.36(b) Standard: Competency Evaluation In-Service Training

484.36(b)(1) Standard: Applicability

484.36(b)(2) Content and Frequency of Evaluations and Amount of In-Service Training

484.36(b)(3) Standard: Conduct of Evaluation and Training

484.36(b)(4) Standard: Competency Determination

484.36(b)(5) Standard: Documentation of Competency Evaluation

484.36(b)(6) Standard: Effective Date

484.36(d) Standard: Supervision

484.36(d)(1)

484.36(d)(2)

484.36(d)(3)

484.36(d)(4)

484.36(d)(4)(i)

484.36(d)(4)(ii)

484.36(d)(4)(iii)

484.36(e) Personal Care Attendant (PCA): Evaluation Requirements

484.38 Condition of Participation: Qualifying to Furnish Outpatient Physical Therapy or

Speech Pathology Services

484.48 Condition of Participation: Clinical Records

484.48(a) Standard: Retention of Records

484.48(b) Standard: Protection of Records

484.52 Condition of Participation: Evaluation of the Agency’s Program

484.52(a) Standard: Policy and Administrative review.

484.52(b) Standard: Clinical Record Review

484.55 Condition of Participation: Comprehensive Assessment of Patients

484.55(a) Standard: Initial Assessment Visit

484.55(a)(1)

484.55(a)(2) 484.55(b) Standard: Completion of the comprehensive assessment.

484.55(d) Standard: Update of the comprehensive assessment.

484.55(e) Standard: Incorporation of OASIS Data Items

The Interpretive Guidelines serve to interpret and clarify the Conditions of Participation

for home health agencies (HHAs). The Interpretive Guidelines merely define or explain

the relevant statute and regulations and do not impose any requirements that are not

otherwise set forth in statute or regulation.

Conduct the HHA survey in accordance with the appropriate protocols and look to the

substantive requirements in the statute and regulations to determine whether a citation of

non-compliance is appropriate. Base any deficiency on a violation of the statute or

regulations, which, in turn, is to be based on observations of the HHA’s performance or

practices. (See 2712.)

4