Patient Rights Requirements

Breaking Down the New Home Health Conditions of Participation: Patient Rights Requirements

Update: On Friday, March 31, 2017, CMS issued a proposed rule to change the new Home Health Conditions of Participation effective date from July 13, 2017 to January 13, 2018. While this change in effective date is currently just a proposed rule, it is expected that the final rule will be consistent with the proposal. We will update our blog as more information becomes available. Despite the potential for delay, home health agencies should not cease or postpone preparation for the new CoPs.

To help you prepare for the new Conditions of Participation, HEALTHCAREfirst has partnered with home health care consultant and regulatory expert, Mary St. Pierre, RN, BSN, MGA, for a series of blog articles regarding the regulatory changes to the CoPs that will likely require amended policies, procedures, and forms.

In parts one and two of our blog series on the Home Health Conditions of Participation (CoPs), we discussed QAPI, infection prevention and control, as well as care planning, coordination, and quality of care. In this article, Mary will go over the new patient rights requirements. Please note that this is only a summary of many of the CoP changes and you should refer to the revised Conditions of Participation for complete details.

Patient Rights
There were many changes to the patient rights condition of participation. Much of this involves more specificity in the requirements that will necessitate adoption of new patient rights notices and policies.

Standard: Notice of Rights
This standard indicates that the home health agency must provide a written notice of rights and responsibilities in advance of care to the patient and the patient’s legal representative (if applicable) or within 4 business days of initiation of care to the patient’s selected representative (in applicable). This notice must be understandable to those with limited English proficiency and individuals with disabilities, and written confirmation of receipt must be obtained. The notice should contain:

  • Transfer and discharge policies
  • Contact information for the home health administrator, including his/her name, business address, and phone number
  • OASIS privacy notice (remained unchanged)

Additionally, the home health agency must provide a verbal notice of rights and responsibilities no later than the end of the second professional visit. The verbal notice must be made in the patient’s primary or preferred language.

Standard: Exercise of Rights
In this standard, a court appointed “legal” representative or patient self-selected representative may elect to exercise the patient’s rights.

Standard: Rights of the Patient
This standard expands the rights of the patient somewhat. The patient must be free from verbal, mental, sexual, and physical abuse, as well as injuries of unknown source, neglect, and property misuse.

Additionally, the patient must be allowed to participate in, be informed about, and consent or refuse throughout:

  • Completion of all assessments
  • Care to be furnished
  • Establishing and revising the plan of care
  • The disciplines that will furnish the care
  • The frequency of visits
  • Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits;
  • Any factors that could impact treatment effectiveness; and
  • Any changes in the care to be furnished

The standard says that payment information or changes in payment is to be given as soon as possible in advance of the next visit (before services are furnished).

Patients are to have written notice in advance of a specific service if that service is non-covered and in advance of reducing or terminating ongoing care.

An additional requirement under this standard is that the home health agency is required to give patients the names, addresses and telephone numbers of federal and state agencies that have been established to help Medicare beneficiaries and the elderly.

Lastly, patients are to be informed of the right to access auxiliary aids and language services, and how to access these services.

Standard: Transfer and Discharge
This standard says that patients have the right to be informed of the home health agency’s transfer and discharge policies. The agency may only transfer or discharge the patient:

  • For the patient’s welfare and the agency and responsible physician agree that the agency can no longer meet the patient’s needs based on the patient’s acuity. The home health agency must arrange for safe and appropriate transfer to another care entity.
  • The patient or payer will no longer pay for services.
  • The responsible physician and home health agency agree that the measurable outcomes/goals and services no long needed.
  • The patient refuses services and elects to be transferred or discharged.
  • Under a policy set by the agency for the purpose of addressing discharge for cause: disruptive, abusive, or uncooperative behavior that interferes with ability to provide care/operate effectively after:
    • Advising patient, representative, the physician(s) post discharge caregivers of discharge
    • Making efforts to resolve the problem(s)
    • Providing contact information for other agencies or providers.
    • Documenting the problem(s) and efforts made to resolve the problem(s), and enter this documentation into its clinical records.
  • Patient death.
  • Home health agency ceases to operate.

Standard: Investigation of Complaints
Current requirements regarding investigation of complaints are still in place. But, more detailed reasons of what the patient can complain about have been added, including mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and/or misappropriation of patient property by anyone furnishing services on behalf of the home health agency.

Home health agencies have to take action to prevent further potential violations, including retaliation, while the complaint is being investigated. Additionally, any agency staff (employed & contract) seeing incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property must report these findings immediately to the HHA and other appropriate authorities in accordance with state law.

Standard: Accessibility
Information must be provided to patients in plain language and in a manner that is accessible and timely to:

  • Persons with disabilities, including accessible websites and the provision of auxiliary aids and services at no cost to the individual in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.
  • Persons with limited English proficiency through the provision of language services at no cost to the individual, including oral interpretation and written translations.

In the next blog article in this series, Mary will discuss Comprehensive Assessment of Patients, Skilled Professional Services, and Home Health Aide Services. Be sure to subscribe to our blog  to get notifications when new articles in this series are posted!

Have questions about the patient rights requirements or the CoPs in general? Read our FAQ that addresses home health agencies’ most common questions and concerns. You can also register for a webinar on May 18th where we will provide an in-depth discussion of the new CoPs and what you should be doing now to prepare.

 

About Mary St. Pierre, RN, BSN, MGA

Mary St. Pierre worked was employed as a registered nurse by the Visiting Nurse Association of Trenton and St. Francis Hospital in New Jersey, followed by 24 years as a home care nurse, clinical supervisor and branch manager with the Visiting Nurse Association of Washington, DC (now MedStar VNA).

Before retiring in 2013 she oversaw the operations of the Regulatory Affairs Department of the National Association for Home Care & Hospice (NAHC) for 20 years, tracking regulations and influencing regulatory bodies (e.g. CMS, FDA, OSHA). She wrote articles, prepared educational programs, presented speeches and programs and kept the NAHC membership abreast of regulatory, Medicare coverage, quality, and clinical information.

Since retirement, Mary has served as a consultant, providing clinical, operational, and regulatory guidance to the home health industry. She currently provides services exclusively to HEALTHCAREfirst.

April 20, 2017

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