Legal Eagle Eye Newsletter for the Nursing Profession (7)3 Mar 99
We are reporting verbatim the essence of HCFAs new regulations for assessment of home health patients and for electronic reporting of assessment data.
We have left out HCFAs lengthy statement of the rationale for the new policy, as well as the regulations which apply to state agencies rather than providers.
These regulations apply to every home health agency that is and wants to remain eligible for Medicare reimbursement. FEDERAL REGISTER, January 25, 1999 Pages 3747 3785.
This final rule revises the existing conditions of participation that home health agencies (HHAs) must meet to participate in the Medicare program. Specifically, this rule requires that each patient receive from the HHA a patient-specific, comprehensive assessment that identifies the patients need for home care and that meets the patient's medical, nursing, rehabilitative, social and discharge planning needs. In addition, this final rule requires that as part of the comprehensive assessment, HHAs use a standard core assessment data set, the "Outcome and Assessment Information Set" (OASIS) when evaluating adult, non-maternity patients. These changes are an integral part of the Administrations efforts to achieve broad-based improvements in the quality of care furnished through Federal programs and in the measurement of that care.
EFFECTIVE DATE: These regulations are effective on February 24, 1999.
Sec. 484.18 Condition of participation: Acceptance of patients, plan of care, and medical supervision.
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(c) Standard: Conformance with physician orders. Drugs and treatments are administered by agency staff only as ordered by the physician. Verbal orders are put in writing and signed and dated with the date of receipt by the registered nurse or qualified therapist (as defined in Sec. 484.4 of this chapter) responsible for furnishing or supervising the ordered services. Verbal orders are only accepted by personnel authorized to do so by applicable State and Federal laws and regulations as well as by the HHAs internal policies.
Sec. 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment that accurately reflects the patients current health status and includes information that may be used to demonstrate the patients progress toward achievement of desired outcomes. The comprehensive assessment must identify the patients continuing need for home care and meet the patients medical, nursing, rehabilitative, social, and discharge planning needs. For Medicare beneficiaries, the HHA must verify the patients eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. The comprehensive assessment must also incorporate the use of the current version of the Outcome and Assessment Information Set (OASIS) items, using the language and groupings of the OASIS items, as specified by the Secretary.
(a) Standard: Initial assessment visit.
(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patients return home, or on the physician-ordered start of care date.
(2) When rehabilitation therapy service (speech language pathology, physical therapy, or occupational therapy) is the only service ordered by the physician, and if the need for that service establishes program eligibility, the initial assessment visit may be made by the appropriate rehabilitation skilled professional.
(b) Standard: Completion of the comprehensive assessment.
(1) The comprehensive assessment must be completed in a timely manner, consistent with the patients immediate needs, but no later than 5 calendar days after the start of care.
(2) Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status.
(3) When physical therapy, speech-language pathology, or occupational therapy is the only service ordered by the physician, a physical therapist, speech-language pathologist or occupational therapist may complete the comprehensive assessment, and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. The occupational therapist may complete the comprehensive assessment if the need for occupational therapy establishes program eligibility.
(c) Standard: Drug regimen review. The comprehensive assessment must include a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.
(d) Standard: Update of the comprehensive assessment. The comprehensive assessment must be updated and revised (including the administration of the OASIS) as frequently as the patients condition warrants due to a major decline or improvement in the patients health status, but not less frequently than--
(1) Every second calendar month beginning with the start of care date;
(2) Within 48 hours of the patients return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests;
(3) At discharge.
(e) Standard: Incorporation of OASIS data items. The OASIS data items determined by the Secretary must be incorporated into the HHAs own assessment and must include: clinical record items, demographics and patient history, living arrangements, supportive assistance, sensory status, integumentary status, respiratory status, elimination status, neuro/emotional/behavioral status, activities of daily living, medications, equipment management, emergent care, and data items collected at inpatient facility admission or discharge only.
This interim final rule with comment period requires electronic reporting of data from the Outcome and Assessment Information Set (OASIS) as a condition of participation for HHAs. Specifically, this rule provides guidelines for HHAs for the electronic transmission of the OASIS data set as well as responsibilities of the State agency or HCFA OASIS contractor in collecting and transmitting this information to HCFA. This interim final rule also sets forth rules concerning the privacy of patient identifiable information generated by the OASIS.
Effective Date: February 24, 1999. Applicability Date: Regulations at Sec. 484.20 are applicable for testing of the HHAs transmission system and encoding of OASIS data on March 26, 1999, and for reporting of the HHAs OASIS data on April 26, 1999
Software: HHAs have the option of purchasing data collection software that can be used to support other clinical or operational needs (for example, care planning, quality assurance, or billing) or other regulatory requirements for reporting patient information. However, HCFA has developed an OASIS data entry system (that is, Home Assessment Validation and Entry, or "HAVEN") that is available to HHAs at no charge through HCFAs website at http:// www.hcfa.gov/medicare/hsqb/oasis/oasishmp.htm. HHAs may also request HAVEN on CD-ROM.
Sec. 484.11 Condition of participation: Release of patient identifiable OASIS information. The HHA and agent acting on behalf of the HHA in accordance with a written contract must ensure the confidentiality of all patient identifiable information contained in the clinical record, including OASIS data, and may not release patient identifiable OASIS information to the public.
Section 484.20 Condition of participation: Reporting OASIS information. HHAs must electronically report all OASIS data collected in accordance with Sec. 484.55.
(a) Standard: Encoding OASIS data. The HHA must encode and be capable of transmitting OASIS data for each agency patient within 7 days of completing an OASIS data set.
(b) Standard: Accuracy of encoded OASIS data. The encoded OASIS data must accurately reflect the patients status at the time of assessment.
(c) Standard: Transmittal of OASIS data. The HHA must--
(1) Electronically transmit accurate, completed, encoded and locked OASIS data for each patient to the State agency or HCFA OASIS contractor at least monthly;
(2) For all assessments completed in the previous month, transmit OASIS data in a format that meets the requirements of paragraph (d) of this section;
(3) Successfully transmit test data to the State agency or HCFA OASIS contractor beginning March 26, 1999, and no later than April 26, 1999; and
(4) Transmit data using electronic communications software that provides a direct telephone connection from the HHA to the State agency or HCFA OASIS contractor.
(d) Standard: Data Format. The HHA must encode and transmit data using the software available from HCFA or software that conforms to HCFA standard electronic record layout, edit specifications, and data dictionary, and that includes the required OASIS data set.
FEDERAL REGISTER, January 25, 1999
Pages 3747 3785.
(Please see "Home Health Agencies: HCFA To Require OASIS Data Set For Medicare, Medicaid Patients." Legal Eagle Eye Newsletter for the Nursing Profession (5)4, Apr. 97 p.2.)