1. Home Health Agencies Darlene Augustine, Health Quality Administrator Department of Health Division of Home Health

2. Number of Medicare HomeHealth Agencies • 2008 401 • 2009 410 • 2010 434 • 2011 447 • 4/1/2012 405

3. Top 5 Home Health Deficiencies • Conformance with Physician’s orders (G0165) • Assignment & Duties of Home Health Aide (G0224) • Physician’s Plan of Care (G0160) • Acceptance of Patients, POC, Med Sup (G0158) • Compliance with Fed, State, Local Laws (G0118)

4. HHA Survey Protocols • Focus – Data driven survey • Changes scope of standard survey • Evaluates 9 of 15 Conditions • Patient –focused, outcome –oriented • Limited paper review • Review of outcome data prior to survey • HHA Survey Investigation Worksheets

5. HHA Survey Protocols • Efficient: • Increased use of HHA interview, data • Paper review limited to PE or Extended • Guidelines for citation of deficiencies • Effective: • Targeted patient care standards • Enhanced consistency in deficiency citations

6. Survey Protocols • Standard survey – Level 1 standards • Most relate to patient care processes • Partial Extended survey – Level 2 standards • Guidelines for further investigation • Condition level guidance • Related conditions for further investigation • Extended survey – condition cited, all examined

7. Standard Survey Protocols • Level 1 standards • Focus on delivery of quality patient care • Address 9 of 15 Conditions • Increased use of interviews • Minimal need to review non-clinical paper • Compliance with all Level 1 – survey ends

8. Standard Survey Expands • Expected outcomes not met for 1 or more Level 1 standards • Surveyor recognizes other issues • Survey becomes Partial Extended survey • Level 2 standards are evaluated • Surveyor discretion -Review additional standards under same condition or related conditions

9. Condition Level Deficiencies • Guidelines for citing conditions • Guidelines, not requirements • May be cited for serious findings unrelated to Level 1 or 2 standards • Immediate jeopardy - always condition • Extended survey – all conditions reviewed

10. Home Health Complaints – 4/1/11 – 4/1/12 • Total # HHA – 405 • # HHA w complaints – 50 • % of Substantiated Complaints – 14 • % of Unsubstantiated Complaints- 36

11. Medicare Hospice Agencies • 2008 171 • 2009 179 • 2010185 • 2011 187 • 2012 191 • 19 In-patient facilities

12. Top 5 Hospice Deficiencies • Time Frame for Assessment Completion (L523) • Content of Comprehensive Assessment (L524) • Plan of Care (L543) • Review of the Plan of Care (L552) • Coordination of Services (L554)

13. Medicare Hospice Complaints 4/1/11 – 4/1/12 • Total # of Hospice Agencies- 191 • Total # of Hospice Complaints- 31 • % of Substantiated Complaints- 10 • % of Unsubstantiated Complaints- 21

14. OASIS • Top Online Resources • OASIS Implementation Manual - www.cms.hhs.gov/OASIS/05_UserManual.asp • CMS Q&As - https://www.qtso.com/hhadownload.html • OASIS Certificate & Competency Board - www.oasiscertificate.org

15. OASIS • Pa OASIS Education Coordinator • Sandra Kowalczyk (skowalczyk@pa.gov) Contact # (570) 963-4212

16. Contact • Department of Home Health • http://www.health.state.pa.us • Division of Home Health 132 Kline Plaza, Suite A Harrisburg, Pa 17104 717-783-1379