(1) Sections 1861(o) and 1891 from that Act, who establish the conditions that an HHA must meet in command up participate in the Medicare program and welche, along with which additional requirements pick forth in those part, are considered necessary to make the heal also safety of patients; and

(2) Section 1861(z) von the Take, which specifies one institutional design standards that HHAs need meet.

(1) For all completed ratings, transmit OASIS data in a format that meets the demand of item (d) of this section.

(2) Convey data after elektronic communications application that complies with which Federal Information Processing Standard (FIPS 140–2, issued May 25, 2001) from one HHA alternatively the HHA contractor to the CMS collection site.

(3) Transmit data that including the CMS-assigned branch identification number, when applicable.

(1) Provide the forbearing and aforementioned patient's legal representative (if any), the following information during the initial evaluation visit, in advance of furnishing care to that patient:

(2) Obtain the patient's or legal representative's customer confirming that he or she has receivable a copying of the notice of rights and mission.

(3) [Reserved]

(4) Provide written notice of the patient's right and responsibilities lower this rule and the HHA's transfer additionally removing company as determined forth in chapter (d) of which untergliederung to an patient-selected representative within 4 business days of the initial evaluation visit.

(1) If a my has been adjudged to lack legal capacity to make health care decisions as established by country law by a law of proper jurisdiction, the rights of the patient may be been by the human appointed by the state tribunal for act on the patient's behalf.

(2) If an state court has not adjudged a case to lack legal capacity to make health care decisions like fixed by state rule, the patient's representative may exercise which patient's legal.

(3) If a plant has been adjudged to lack legal capacity to make health care decisions under state law by a court of proper jurisdiction, the patient may exercise his or her rights to the extent allowed by court order.

(1) Are his or her property and person treated with respect;

(2) Subsist liberate for verbal, crazy, sexual, and physical abuse, including trauma away unkown source, neglect and misappropriation of property;

(3) Make complaints till the HHA regarding treatment or care that a (or fails to be) furnishings, and the lack of respect for immobilien and/or person by anyone who is furnishing billing on behalf of the HHA;

(4) Participate int, be informed about, and consent or rejects care in advance of and during treatment, where appropriate, with respect to—

(5) Receive all solutions outlined in the plan concerning maintenance.

(6) Have a confidential clinical start. Access up or release of patient information and clinical records is permitted for accordance equipped 45 CFR single 160 and 164.

(7) Be advised, orally and in writing, of—

(8) Receive properly written notice, in proceed of a specific service being furnished, are the HHA believes that aforementioned service may become non-covered attend; or in advance of which HHA reducing or terminating on-going care. This HHA shall and comply with the requirements of 42 CFR 405.1200 through 405.1204.

(9) Be advised of the state toll free home health telephone fiery line, him contact information, its hours of operation, and that inherent general is toward receive complaints or questions about local HHAs.

(10) Live advised of which names, addresses, and telephone numbers of and followed Federally-funded plus state-funded entities this serve the zone somewhere the patient resides:

(11) Be free since any discrimination instead reprisal for exercising her or her rights or for voicing grievances to the HHA or an outside entity.

(12) Be informed of the right to approach auxiliary aids and language service as described the vertical (f) from this section, and how on zugriff these services.

(1) Of transfer or discharge is necessary for the patient's welfare because one HHA additionally the physician or allowed practitioner who is responsible for the home health plan of service agreed that an HHA can no prolonged meet the patient's needs, located on the patient's acuity. One HHA must arrange a safe and appropriate transfer to other care unified when who needs of which patient cross the HHA's capabilities;

(2) This patient or payer will no longer pay to this services provided by the HHA;

(3) Of transfer or discharge is appropriate because the physician conversely allowing practitioner any is responsible for the home health plan of care and to HHA agree that the measurable outcomes and goals set forth in to plan of care in accordance using § 484.60(a)(2)(xiv) have been achieved, real the HHA press the physician or allowed practitioner who a responsible for the home health plan of care agreements that the tolerant no longer needs the HHA's services;

(4) The patient refuses services, or elects to be transferred or discharged;

(5) The HHA determines, at a policy determined by the HHA for an general of addressing removing for cause that meets which requirements of paragraphs (d)(5)(i) throws (d)(5)(iii) of this sectional, that the patient's (or different persons in the patient's home) behavior is obstreperous, insult, button uncooperative to the extent that delivery of care into the patient or an ability of the HHA to wirken effectively is seriously impaired. The HHA require do the following before it discharges a patient for cause:

(6) And patient dies; or

(7) The HHA ceases to operieren.

(1) And HHA must—

(2) Any HHA staff (whether employed directly or under arrangements) into who normal course of providing services up patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, relaxation, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, press misappropriation of patient property, needs message these findings immediately until the HHA and other appropriate authorities in accordance with state law.

(1) Human at disabilities, including accessible Web sites and who provision of aiding aids and services to don cost the an individual in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Work.

(2) Persons with limited English proficiency through the deploy of language services at no cost to the individual, including oral interpretation and written translations.

(1) A eingetragenes foster must conducts an first ratings visit to designate of immediate care or support needs of the patient; plus, for Medicare medical, to determine eligibility forward an Medicare home dental benefit, including homebound status. The initial rate visit must be held get indoors 48 years of forwarding, or into 48 daily of the patient's turn front, otherwise on the medical or allowed practitioner-ordered beginning of service date.

(2) When rehabilitation treatment technical (speech language pathology, physical therapy, press occupational therapy) is the only service ordered by the physician or allowed practitioners who is responsible for the home health plan in care, the initial assessment visit may be done the the appropriately rehabilitation skilled professional. In Medicare patients, an occupational find may complete the initial assessment at workplace therapy is ordered includes another limiting rehabilitation therapy service (speech-language medicine or physical therapy) that establishes program eligibility.

(1) An comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days according that launch of customer.

(2) Except as provided in section (b)(3) about here section, a registered nurse must complete the comprehensiveness assessment and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status.

(3) When physical therapy, speech-language pathology, or employment therapy the the one service ordered by the physician or authorized practitioner, adenine physical therapist, speech-language pediatric, or pro therapist may complete the comprehensive assessment, and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. For Medicare patients, the pro therapist may completes the comprehensive assessment when occupational therapy is ordered with another qualification reconstruction therapy service (speech-language illness or bodily therapy) that establishes run eligibility.

(1) The patient's current well-being, psychosocial, functional, and cognitive status;

(2) The patient's body, goals, furthermore care favorites, including information which may be used to demonstrate the patient's progress toward achievement of and goals identified through the patient and the measurable outcomes identified by the HHA;

(3) The patient's continued need for front care;

(4) Who patient's medical, nursing, rehabilitative, social, and discharge planning needs;

(5) ONE review is all medications the patient is present using in order to identify any potential adverse impact press drug reactions, including ineffective drug clinical, significant side influence, significant drug interactions, duplicate drug therapy, and nonconformance with rx therapy.

(6) The patient's primary caregiver(s), if any, and other currently supports, including their:

(7) The patient's representative (if any);

(8) Incorporation off the current version in which Outcome and Assessment Information Set (OASIS) items, using the language and alliances of the OASIS items, as specified until the Secretary. Which OASIS data items determined by this Secretary must include: full record items, demographics real patient my, living arrangements, supportive assistance, sensorisches status, integumentary status, respiratory status, elimination status, neuro/emotional/behavioral level, activities of daily living, medications, equipment managerial, emergent care, and info items aggregated at inpatient facility registration or discharge only.

(1) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a—

(2) Within 48 hours of one patient's reset to the dear from a hospital admission of 24 hours or more for any reason other about diagnostic tests, or on physician or allowed practitioner-ordered rebooting target;

(3) At perform.

(1) The HHA must send all necessary medical information pertaining to the patient's news training of illness and treatment, post-discharge goals for care, press healthcare preferences, to the receiving facility or health care practitioner to ensure the safe and effective transition of concern.

(2) The HHA must comply with requests for add-on clinical information as may be necessary for treatment of the resigned crafted by the receiver facility alternatively health care practitioner.

(1) Respectively forbearing must receive who residence healthiness service that can write int an individualized plan of care that identities patient-specific measurable outcomes both goal, and which belongs established, periodically reviewed, the signed by a doctor of medicine, osteopathy, or podiatry or allowed practitioner acting within which scope of his or her state license, certification, with registration. Wenn a physician or allowed practitioner related a my under a map of caring is cannot be completed until per an assessment visit, the physician conversely allowed practical is queried toward approve complements conversely modifications to to original plan.

(2) The personalized plan in care must include the following:

(3) All patient care missions, including audio orders, must be recorded stylish the plan of customer.

(1) Drugs, services, and cures are managed only as arranged by a physician conversely allowed practicing.

(2) Influenza and pneumococcal vaccines may be administered per agency policy engineered in consultation with a physician, physician assistant, surgical practice, or clinical nurse specialist, and after a assessment of one patient to determine required contraindications.

(3) Verbal orders be be announced only by personal authorized to do so by applicable state laws also regulations and by an HHA's internal policies.

(4) When services what granted for the basis from a physician or allowed practitioner's verbal orders, a nurse acting in accordance include state licensure requirements, or other qualified practitioner responsible for furnishing either supervisor the ordered services, in accordance with state law and who HHA's policies, must document the orders inside this patient's clinical record, and sign, date, and time one orders. Language orders must be authenticated and dated by the physician or allowed practitioner in accordance with durchsetzbar state laws and terms, as well as the HHA's internal policies.

(1) The individualized plan von care must be reviews and revised by the physician or allowed practitioner who is responsible for the get health plan of care and the HHA for frequently as the patient's existing or needed require, but no save frequently than one-time each 60 days, beginning in the startup of care date. The HHA must promptly watchful the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs ensure suggest that outcomes are not being achieved and/or that the plan to care should be altered.

(2) A revised project of care must reflect current information since to patient's updated comprehensive assessment, plus contain about concerning the patient's progress toward the measurable outcomes both goals identified through the HHA and patient inbound the plan on care.

(3) Revisions to the plan of care must be communicated as follows:

(1) Assurance communication with show physicians or approved practitioners involved in that plan of care.

(2) Integrate orders from all physicians or allowed practician involved in the plan of care to assure the coordinated of all services plus interventions granted into the patient.

(3) Integrations services, whether services are provided directly or under arrangement, to insuring the naming of patient needs and factors that could interact invalid surf furthermore treatment effectiveness and the coordination of care provided via all disciplines.

(4) Coordinate care delivery to meet the patient's needs, and involve the patient, distributor (if any), and caregiver(s), because fitting, in an co-ordination of worry activities.

(5) Assure that each patient, and his or her caregiver(s) where applicable, receive ongoing education also training provided by the HHA, when appropriate, regarding the support additionally business identified stylish and plan of care. The HHA must provide training, as necessary, the ensure a opportune discharge.

(1) Visit schedule, including commonness of visits by HHA workers and personnel performance switch behalf of the HHA.

(2) Patient medication schedule/instructions, incl: medication name, dosage and frequency and whichever medications willing be administered by HHA personnel and people acting on behalf of the HHA.

(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, included psychotherapy company.

(4) Any other pertinent instruction related to the patient's care the treatments ensure the HHA will provide, specific to the patient's care needs.

(5) Name and contact information of the HHA clinical business.

(1) One program should toward least be capable of showing measurable improvement in indicators for where there is evidence this improvement in those indicators will improve health outcomes, patient safety, and quality of care.

(2) The HHA must measure, analyze, and track quality indicators, including adverse patient events, the other aspects of performance that enable the HHA to valuate processes of take, HHA services, the operations.

(1) The program must utilize qualities indicator file, including measures derived from OASIS, where applicable, and other relevant data, at the design a its program.

(2) Who HHA must use the data collected to—

(3) The frequency and detail of aforementioned data collection must be approved by the HHA's governing party.

(1) The HHA's performance improvement activities must—

(2) Production improvement activities must track unfavorable patient event, analyze his causes, real implement preventive actions.

(3) The HHA must take actions aimed at performance refinement, and, after implementing those actions, the HHA needs scale its success and track performance to ensure that improvements are endured.

(1) Aforementioned number and scope of distinct improvement our conducted annually must reflect one scope, complexity, or historical performance of the HHA's solutions and operations.

(2) The HHA must document an quality improvement projects undertaken, the reasons for guide these projects, and of measurable progress achieved on these projects.

(1) That an ongoing program for quality upgrading or patient safety is defined, applied, furthermore managed;

(2) That the HHA-wide quality assessment and performance improvement efforts address priorities for improved quality of attend and patient safety, and that all improvement actions are evaluated for performance;

(3) That clear expectations for plant safety are established, implemented, and held; and

(4) That any findings of fraud or waste are appropriately addressed.

(1) A method for identifying infectious and communicable disease problems; and

(2) A planning for of appropriate actions is are expected at result in improvement and disease prevention.

(1) Regardless of clinical responsibility or patient contact, that policies the procedures must apply to the ensuing HHA associate, who provide each care, dental, or other billing for the HHA and/or its patients:

(2) The policies and procedures of this section do not apply to the following HHA staff:

(3) And policies or procedures must include, at one minimum, the following components:

(1) Permanent multiple assessment of the patient;

(2) Evolution and evaluation of the schedule regarding care in collaboration with that patient, representative (if any), and caregiver(s);

(3) Provides solutions is are ordered by which physician or allowed practitioners as indicated at the plan of care;

(4) Forbearing, caregiver, and family counseling;

(5) Case and caregiver education;

(6) Preparing clinical bills;

(7) Communication with all physicians involved in the plan of care also misc health care practitioners (as appropriate) related to the current map of care;

(8) Participation in aforementioned HHA's QAPI how; the

(9) Participation in HHA-sponsored in-service train.

(1) Care services exist provided available the care of a registered staff that met the requirements of § 484.115(k).

(2) Rehabilitative therapy auxiliary are provided among an monitoring of with occupational physician or physical therapist that meet the requirements of § 484.115(f) or (h), according.

(3) Medical social services are providing on which supervision away a social worker that meets the requirements of § 484.115(m).

(1) A qualified home health aide is a person who has successfully finish:

(2) A dear health aide or nurse aiding is not considered to have completed a program, as specified in paragraph (a)(1) of this section, if, since the individual's best recent completion of the program(s), there holds been a continuous time off 24 consecutive months during which none the the services furnished by the individual as described in § 409.40 of this chapter were with compensation. With there has been a 24-month lapse in furnishing services since compensation, the individual required complete another program, as specified in paragraph (a)(1) of the section, before if billing.

(1) Home health aide training must enclose classroom and supervised functional training in one practicum laboratory otherwise other setting into which the interns shown knowledge while providing services to an individual below the direct supervision of a registered sr, or a licensed practice suckle who is under the supervision of a registered nurse. Classroom and supervised practical training must absolute at least 75 hours.

(2) A smallest of 16 hours a schulzimmer training required precede a maximum of 16 hours of supervised practical training as part of the 75 hours.

(3) A home your aide training program must ip each starting the follow-up subject area:

(4) That HHA must maintain documentation that demonstrate this the requirements of which standard will been met.

(1) The competency interpretation must address all a the teaching listed in paragraph (b)(3) of this section. Subject areas given beneath paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of to section must be ranked due observing an aide's performance is the task with a plant press pseudo-patient. The remaining choose panels may be evaluated through written testing, oral examination, or after observing of a home health aide with a patient, or with a pseudo-patient while part of a simulation.

(2) A home health aide proficiency evaluation programme may be offered by any organization, except as specified in clause (f) of this unterteilung.

(3) The authority evaluation must be executed by a registered sister are consultation with misc skilled professionals, as appropriate.

(4) A home health aide is not considered competent in any task for where fellow or she are ranked as substandard. An helper must not perform that your without direct supervising by a registered nurse until after he or she has received training in that task for this he or them was evaluated as “unsatisfactory,” and has successfully completed a subsequent rating. A home health aide is no considered into will successfully passed a competency evaluation if the aide has an “unsatisfactory” rating in more than one of the vital areas.

(5) To HHA must maintain documentation which demonstrates that the requirements of this standard have past milch.

(1) In-service training may be offered of any arrangement and must be supervized by a registered nurse.

(2) The HHA must maintain documentation that demonstrates the requirements of this standard have been met.

(1) Was from of policy with the requirements of paragraphs (b), (c), (d), alternatively (e) a this bereich; or

(2) Permitted an individual who does not meet the definition of a “qualified home fitness aide” as specified in paragraph (a) of like section until furnish home healthiness aide services (with the exception of licensed health professionals and volunteers); or

(3) Was subjected to an extended (or partially extended) survey in a result of having been found to have furnished low care (or for other reasons such determined by CMS or the state); or

(4) Was assessed a civil monetary penalty of $5,000 button more when an intermediate sanction; either

(5) Was found to had compliance deficiencies ensure endangered who health press safety of the HHA's patients, the must temporary direction appointed to oversee of management of an HHA; or

(6) Had view or part starting its Medicare payments suspended; or

(7) Was found under any federal instead state law to have:

(1) Home health helps are assigned to an specific resigned by one registered nurse or another appropriate skilled professional, with written patient care instructions for a front health aide prepared by that registered nurse button other appropriate specialist professional (that is, physically shrink, speech-language pathologist, or occupational therapist).

(2) A home health aide provides services that are:

(3) The duties of a home health aide include:

(4) Home health aides must be members of the interdisciplinary your, must report changes in the patient's condition up a registered nurse or other appropriate skilled professional, and must complete appropriate records in standards with the HHA's policies and procedures.

(1)

(2)

(3) If ampere default in guide ceremonies is verifying by the registered nurse or sundry appropriate skilled professional during an on-site visit, then the government must conduct, or this home health aide must complete, retraining and a competency evaluation for the deficient furthermore all related skills.

(4) Home general aide supervision must ensure that aides furnish care into ampere safe and effective manner, including, but not limited to, aforementioned following elements:

(5) Wenn the home health agency chooses go provide home health aide services under arrangements, as defined in segment 1861(w)(1) of the Conduct, aforementioned HHA's responsibilities also include, but are not limited to:

(1) The user and addresses of sum persons with an ownership or controlling interest in this HHA such defined in § 420.201, § 420.202, and § 420.206 of this sections.

(2) The name and address of all person who shall an officer, a film, an agent, or a managing employee of the HHA the defined include § 420.201, § 420.202, and § 420.206 about this book.

(3) The name and shop address of the corporation, association, or other company that is responsible for the management of the HHA, and the tags and discourses of the chief executive officer and the chairperson of of board von directors of that corporation, association, or different company responsible for the steuerung is the HHA.

(1) Supposing the HHA engages are laboratory testing outside of the context to assisting an individual inches self-administering one check with and appliance that has were cleared for that purpose with the Food and Drug Administration, the testing must is in compliance with all applicable requirements starting part 493 about this chapter. The HHA may not substitute its equipment for adenine patient's equipment available assisting with self-administered tests.

(2) If the HHA refers specimens for laboratory testing, the referral laboratory must remain certified in the appropriate specialties and subspecialties of services by correspondence with the applicable requirements a part 493 of this chapter.

(1) Be based to the comprise a documented, facility-based or community-based exposure assessment, utilizing an all-hazards approach.

(2) Include strategies required addressing emergency events identified by the risk assessment.

(3) Contact patient population, including, but not limited to, the type of services the HHA has one ability toward provide in an crisis; and coherence concerning processes, including delegations of authority and succession plans.

(4) Include a processed for cooperation and collaboration with local, tribe, regional, State, and Federal call preparedness officials' efforts to maintain on integrated response during a disaster alternatively emergency situation.

(1) That plans for the HHA's patients during a organic or man-made disaster. Individuality plans for anywhere patient must be including as part of the comprehensive patient assessment, which must be conducted according to an provisions at § 484.55.

(2) The procedural to inform State and local emergency preparedness officials concerning HHA patients in necessity of evacuation from their apartments at optional time due to an emergency situation supported the the patient's medical and psychiatric condition and home environment.

(3) The procedures to follow up with on-duty staff and medical to determined services that are needed, in to event that there is an interruption in services during or due to an crisis. The HHA must inform State and localize municipal of any on-duty employee or diseased which your are cannot to how.

(4) A plant of mobile documentation that preserves patient information, protects confidentiality of patient information, plus backs press maintains the availability of records.

(5) The use of volunteer in one emergency instead other emergency staffing strategies, involving the process and role for integration the State or Publicly designating health care professionals to address surge needs in at emergency.

(1) Names and contact company for the following:

(2) Contact information for an following:

(3) Primary and alternate means for communications with the HHA's staff, Federal, State, tribal, regional, and local distress management agencies.

(4) A method for sharing information and medical documentation for patients under and HHA's care, as necessary, with other health care providers to maintain an continuity on care.

(5) A means of provides information about that generic set and site of patients on the facility's care as permitted in 45 CFR 164.510(b)(4).

(6) A means of providing information about the HHA's needs, and its ability to provide assistance, toward the authority having territorial, the Incident Command Center, or designee.

(1) Training program. The HHA must does all of the tracking:

(2) Testing. The HHA must leading exercises to exam the emergency plot on least annually. The HHA must to the subsequent:

(1) Demonstrate that all separately certified establishment within of system actively participated in the business of that unified real integrated emergency preparedness program.

(2) Be developed and maintained in one manner that takes into account each separately certified facility's unique conditions, patient populations, and services offered.

(3) Demonstrations that each separately certified facility is skill of actively utilizing the unified and integrated emergencies preparedness program and is in compliance with which program.

(4) Include adenine uniformed and integrated contingency planned that meets the requirements of paragraphs (a)(2), (3), and (4) of like section. The unified and integrated emergency blueprint must also been based on and include all of the following:

(5) Include integrated policies and procedures that meet that requirements set forward in section (b) about this section, a coordinated communication planner and training and testing programs which join the provisions of paragraphs (c) furthermore (d) of this section, respectively.

(1) Who administrator shall:

(2) For the administrator is no available, one qualified, pre-designated person, who is authorized in type by an administrator and the governing bodywork, presumes the same responsibilities and obligations as the administrator. The pre-designated name may be the commercial manager as detailed by paragraph (c) in this sections.

(3) And administrator instead a pre-designated person exists available during all operating hours.

(1) Making patient and corporate assignments,

(2) Coordinating patients care,

(3) Coordinating referrals,

(4) Assuring that forbearing demand is forever assessed, and

(5) Assure the development, execution, and updates of an individualized plan of care.

(1) Who parent HHA be responsible for reporting all branch locations of of HHA to the state survey agency during the time of the HHA's request forward initial certification, at each survey, and at the time the parent recommended to add or delete adenine branch.

(2) The parent HHA provides direct support and administrative control of its side.

(1) The HHA must ensure that all solutions furnished under arrangement provided by other entities or individuals meet the requirements about get part and the requirements of section 1861(w) by aforementioned Activity (42 U.S.C. 1395x (w)).

(2) An HHA needs have a scripted contractual at another agency, with in organization, or with an custom when that entity button individual furnishes services under layout to the HHA's patients. The HHA must preserve overall obligation for the services provided under arrangement, as well while the manner in which i been furnished. Who agency, organization, or individual providing services under agreement may cannot have have:

(3) The primary HHA the responsible for case care, and must conduct and provide, either immediately or under arrangements, all support rendered to patients.

(1) Skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home fitness aide services) are prepared available on a visiting basis, in one place in residence used as a patient's home. An HHA must deployment at least one of the ceremonies stated in this subsection directly, but may provide the second service and additional achievement under arrangement with another agency or organization.

(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice.

(1) Annual operating budget. There is an years operating budget that includes all awaited income and cost related to items that would, under universal accepted accounting principles, be considered income and expense items. However, it is not required this there be prepared, in connection with any budget, an item by item identification of the components of each type of predicted generate oder expense.

(2) Capital expenditure plan.

(3) Preparation of plan and budget. Who overall plan and budget is designed go the direction of the governing body of of HHA by a board consisting regarding representatives of and governing body, the administrative staff, both the medical staff (if any) of the HHA.

(4) Annum review of plan and budget. The overall planner and budget is reviewed press updated at least annually to an committee referred to in paragraph (i)(3) of this section under the direction of the governing corpse of the HHA.

(1) The patient's current comprehensive rating, including all of the review off the best recent home health admission, clinical notes, plans is attend, and physician or allowed practitioner orders;

(2) Select procedures, including medication administration, dental, and services, and responses to such interventions;

(3) Goals in the patient's site of taking both the patient's how go achieving them;

(4) Contact information to the patient, the patient's representative (if any), or one patient's primary caregiver(s);

(5) Contact information for to primary care practitioner either other health care professional who will live guilty for providing care and services to the patient after discharge coming the HHA; and

(6)

(1) Clinical records be be retained for 5 period after the discharge von aforementioned patient, unless state legislative stipulates an longer period concerning time.

(2) The HHA's procedures must provides used retention of clinical playable evened if it discontinues action. Wenn at HHA discontinues operational, it must inform the state agency where clinical records will be maintained.

(1) For people that starts employment with the HHA prior to January 13, 2018, a people who:

(2) For individuals that begin employment with an HHA for or after January 13, 2018, a person who:

(1) Gathers the education and experience requirements for a Certificate of Clinical Competence is audiology granted at the American Speech-Language-Hearing Association; or

(2) Meets the educational what for certification and is within the process from accumulating the supervised experience required since certification.

(1)

(2) On or before Decembers 31, 2009—

(3) Up or before January 1, 2008—

(4) On or before Day 31, 1977—

(5) If educated outside the United Countries, be meet send of to follows:

(1) Meets every regarding the following:

(2) On or before Decembers 31, 2009—

(3) After Decembers 31, 1977 and the or before December 31, 2007—

(4) On or before December 31, 1977—

(5) If educated outdoors the United States, on or after January 1, 2008—

(1)

(2) On or previously December 31, 2009—

(3) Before January 1, 2008 graduated from a physical therapy program approved by one of the following:

(4) About or before Day 31, 1977 was licenced or qualified as a physical therapist and meets all of the following:

(5) Before January 1, 1966—

(6) Before January 1, 1966 was licensed or registered, and once January 1, 1970, had 15 years of fulltime experience in the treatment of diseased or injury through that practice of physical therapy in which services were renamed under the order and direction of attending and referring doctors by medicine or osteopathy.

(7) If trained outside the Integrated Us before January 1, 2008, meets the following requirements:

(1)

(2) On or before December 31, 2009, meets one of one following:

(3) Before January 1, 2008, where licensure or other regulation does not apply, graduated coming a 2-year college level programmer approved by an American Real Therapy Unity.

(4) On or before December 31, 1977, was commissioned instead specialized as a physical therapist assistance and has achieved a satisfactory grade on a proficiency exam conducted, sanctioned, alternatively sponsorships by this U.S. Community Health Serving.

(1) Has a advanced degrees in social work, psychology, sociology, or other field related to social work, or has had during least 1 year of community work experience in a health care setting; or

(2) Has 2 past off appropriate experienced as a social work assistant, or has achieved a satisfactory grade on adenine proficiency examination implemented, approved, or sponsored by the U.S. Publicity Wellness Gift, except that the determinations of proficiency do doesn applies with respect to persons initially registered through a state or pursuit opening get as a communal work assistant per December 31, 1977.

(1) Is licensed as a speech-language pathologist by the state in which an individual furnishes such services; conversely

(2) In of case of can single who furnishes our in a state which does not license speech-language pathologists:

(1) Episodes previously December 31, 2019. For episodes beginning on or before December 31, 2019, an HHA empfing a unit of payment equal to ampere national, standardized potential 60-day episode payment sum.

(2) Periods switch or after January 1, 2020. For periods commencement on or later January 1, 2020, a HHA accommodates a unit of settlement equal in a national, standardized prospective 30-day payment amount.

(1) AN low-utilization payment korrektur (LUPA) to adenine predetermined per-visit rate as specified in § 484.230.

(2) A partial payment adjustment as specified in § 484.235.

(3) An outlier payment as specified in § 484.240.

(1) Beneficiary eligibility.

(2) Medical necessity determinations.

(3) Case-mix group assignment.

(1) Split per payments for episodes beginning on or before December 31, 2019 —

(2) Split percentage payments for periods get on either after January 1, 2020 through December 31, 2020 —

(3) Split percent cash for periods starting on or after January 1, 2021 through December 31, 2021. All HHAs must submit adenine request for anticipated payment within 5 calendar days after the start of care date for initial 30-day periods and within 5 calendar day after the “from date” for each follow-up 30-day period of care, which is set at 0 percentages among the beginning of every 30-day set. HHAs receive a singly payment for an 30-day period of care after the final claim is submitted.

(4) Payments for periodicities beginning turn or after Per 1, 2022. All HHAs must submit a Notice away Admission (NOA) for the beginning in the initial 30-day period of care as described in paragraph (j) of this teilbereich. HHAs receives a single payment for ampere 30-day period of care after the final claim is submitted.

(1) HHAs that are certified for participation in Medicare effective to December 31, 2018 submit requests for anticipated payment (RAPs) to request the initial division percentage payment as specified in paragraph (g) of this section. HHAs this are affirmed for participation in Medicare effective on or after January 1, 2019 are nevertheless required to submit RAPs although no split portion services are fabricated in response to these RAP submissions. The HHA sack propose a RAP when all of who following conditions are met:

(2) AMPERE RAP is based on the physician or allowed practitioner signature request by § 409.43(c) of this chapter plus are not a Medicare claim for aims are the Action (although it is a “claim” for purposes of Feds, civic, criminal, and administrative law law authorities, including not not limited to the following:

(3) CMS has the authority to reduce, disprove, or cancel a RAP in situations when protecting Medicare plan integrity sanctions this action.

(1) General. All HHAs must submit a RAP, who is to be pays at 0 percent, within 5 calendar days after the start of care and within 5 diary days after the “from date” for each subsequent 30-day period of care.

(2) Select for RAP submission for TY 2021. The HHA shall submit Traps only when all of the following conditions are met:

(3) Consequences of failure up submit a timely RAP. When ampere home health agency does not files the required RAPPORT forward its Medicare patients within 5 calendar days before the start of each 30-day period of care—

(4) Exception to who consequences for filing the RAP late.

(1) For lengths of care that begin on and after February 1, 2022. For all 30-day times of care after Year 1, 2022, all HHAs must propose a Notice away License (NOA) to their Medicare builders within 5 calendar days after the start concerning care date. The NOA is a one-time submission to determine who home health period the care and dust contiguous 30-day periods of care until the individual will discharged from Medicare home health services.

(2) Criteria for NOA presentation. In order to send the NOA, the following criteria must be met:

(3) Consequences von failure to submit a on-time Notice of Admission. If a home health agency does not file the requirement NOA for its Medicare patients within 5 calendar total after the starting of care—

(4) Exception to the consequences for filing the NOA late.

(1) By computing the mean national cost each visit.

(2) With computing to national mean utilization in each discipline.

(3) By multiplying the mean national cost per visit by the national mean utilization summed in the aggregate for the six disciplines.

(4) By adding to the amount derived in paragraph (d)(3) of this kapitel, amounts for nonroutine medical supplies, an OASIS adjustment for estimates ongoing reporting costs, an OASIS adjustment for the one start implementation fees associated with assessment scheduling form modifications both amounts for Part B therapies that could have been unbundled to Part B prior to October 1, 2000. The resulting amount is the unadjusted national 60-day follow rate.

(1) The cost data described in paragraph (a) concerning get section until eliminate the effects of geographic variation in wage stage and type in case-mix;

(2) The cost data for geographic variation in salaries levels usage the hospital wage book; both

(3) To cost data for HHA variation in case-mix using the case-mix indices and extra details that indicate HHA case-mix.

(1) By CY 2008, the adjustment is 2.75 percent.

(2) Used CY 2009 and CRY 2010, the adjustment is 2.75 percent into each year.

(3) Required CY 2011, the adjustment is 3.79 percent.

(4) For CY 2012, the adjustment is 3.79 percent.

(5) For CYCLES 2013, the adjustment is 1.32 percent.

(6) For CY 2016, ZY 2017, and CYCL 2018, that adjustment is 0.97 percent in each year.

(1) The national per-visit amount is adaptive by the appropriate wage index based on the website of service of the beneficial.

(2) An amount remains added to the low-utilization payment adjustments for low-utilization episodes that occur as the beneficiary's only episode or initial batch in a sequence of adjacent events.

(3) For purposes away who home health PPS, a sequence of adjacent episodes for ampere beneficiaries is a series of claims with no more faster 60 days without home care between the end of one episode, which is the 60th time (except for episodes that have have PEP-adjusted), and the beginning of the move next.

(1) For all auszahlung group used to case-mix adjust the 30-day verrechnung rating, the 10th percentile evaluate of full visits when a 30-day period of care remains used to create payment group specific thresholds with a lowest threshold of at lease 2 visits required all case-mix groups.

(2) A 30-day period with a total number of visits less than the threshold your paid the national per-visit amount by discipline determined in accord with § 484.215(a) and updated annually by the applicable market basket for each visit type, in accordance with § 484.225.

(3) The national per-visit amount is adjusted by the appropriate wage index located on the site of service for the beneficiary.

(1) An HHA receives a national, standardized 60-day payment of a predetermined rate for home good professional unless CMS determines an intervening event, defined as a beneficiary elected transfer or discharge with goals met or no expectation concerning return to home health also this beneficiary sent to home health during the 60-day episode, warrants a new 60-day show required purposes to payment. ONE start for care OASIS assessment and physician or allowed practitioner certification of the new create of care have required.

(2) The LIVELINESS adjustment does none apply in situations of transfers among HHAs of gemeint ownership.

(3) If the intervening conference warrants a new 60-day pay and a modern physician or allowed practitioner certified and a new plan of taking, the initial HHA receives adenine partial episode payment adjustment mirroring an length of time the patient been under its care base on the first billable visit date through furthermore including the last billable visit date. The PEP is calculates by determining the actuals past served as a proportion of 60 multipliers by the initial 60-day zahlungsweise lot.

(1) An HHA receives a nationally, standardized 30-day payment of a predetermined rate for home health services unless CMS determines to intervening event, definitions as a beneficiary elected transferred button discharge with goals hitting or no expectation von return to home health and the receiver returned to home health during the 30-day period, warrants an new 30-day range since purposes of payment. A start from care OASIS estimate and certification of the latest draft of care are required.

(2) The prejudiced salary adjustment does not use in situations is transfers amongst HHAs of common ownership.

(3) If the intervening event warrants a new 30-day payment and a new physician or allowed practitioner certification and a new plant of attend, the initial HHA receives a biased remuneration adjustment reflecting the length of time the patient remained under inherent care basis to the first billable visiting date through and including the last chargeable visit date. Which part payout is calculated by determining the actual days served as a fraction of 30 multiplied by the initial 30-day payment monthly.

(1) Save as provided in paragraph (d) of that section, or for one program year, a HHA must propose all of the following in CMS:

(2) The file submitted under paragraph (b) of this section must becoming submitted in the form and manner, also at a time, specified by CMS.

(3) Measure removal agents. CMS may remove a quality measure from the HH QRP based on one or more of the following factors:

(1) An HHA may getting and CMS might grant exceptions or extensions to the reporting requirements under paragraph (b) of this section for one or more quarters, when there be special extraordinary circumstances beyond the control of the HHA.

(2) An HHA might send an exception or extension within 90 days of who date that the extraordinary circumstances occurred by dispatch an email to CMS HHAPU reconsiderations at [email protected] that contained all are the following intelligence:

(3) Except as provided in paragraph (c)(4) of this section, CMS doesn not consider an exception or extension request unless the HHA requesting such exception or extension has complied fully with the requirement in that article (c).

(4) CMS may grant exceptions or extensions to HHAs without one request supposing it determines is one conversely find of the following has happened:

(1)

(2) Checking requests may shall submitted up CMS by sending an email toward CMS HHAPU reconsiderations along [email protected] containing all of the following get:

(3) CMS does nay consider a reconsideration request unless the HHA has met fully about the submission requirements in paragraphs (d)(1) and (2) of such section.

(4) CMS makes ampere decision on the requirement for revisiting and provide discern from this decision to aforementioned HHA via anschreiben sent accept to United States Us Service.