Home Health & Hospice Week

SOC, reprisal IGs could give agencies trouble.

Home health agencies have a lot to worry about under the new finalized Interpretive Guidelines. Check out two of the top changes to help prioritize your compliance efforts:

• G520: §484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care.

Draft IG: The draft IGs said, “The start of care date is the date of the initial assessment and the comprehensive assessment must be completed within 5 calendar days of that date.”

Final IG: The final IGs say, “The start of care date is considered to be the first visit where the HHA actually provides hands on, direct care services or treatments to the patient. If an initial assessment is completed without any direct care services being provided by the HHA during the assessment visit, the date of that initial assessment visit would not be the start of care date. The comprehensive assessment must be completed within 5 calendar days of the first visit where the HHA provides hands on, direct care services/treatments to the patient.”

The SOC date is important because it triggers when the OASIS is due, notes attorney Robert Markette Jr. with Hall Render in Indianapolis. One of Markette’s clients got a survey citation because the surveyor didn’t agree with the SOC date, and then the OASIS submission date was out of compliance.

Requiring the agency to provide “hands on, direct care services” in the first visit may sometimes “put the cart before the horse,” Markette worries.

• G448: §484.50(c)(11) The HHA must be free from any discrimination or reprisal for exercising his or her rights or for voicing grievances to the HHA or an outside entity.

Draft IG: “Discrimination against a patient as reprisal for exercising the right to complain is defined as treating a patient differently from other patients subsequent to a complaint and without justification for the difference.

“Examples of reprisal may include but not be limited to a reduction of current services, a complete discontinuation of services, or discharge from the HHA subsequent to a complaint and without medical justification for the change of service” (italics added).

Final IG: “‘Discrimination or reprisal against a patient for exercising his or her rights or for voicing grievances’ is defined as treating a patient differently from other patients subsequent to receipt by the HHA of a patient complaint, without a medical justification for such different treatment…

“Examples of discrimination or reprisal include, but are not limited to, a reduction of current services, a complete discontinuation of services, or discharge from the HHA subsequent to receipt by the HHA of a patient complaint, without a medical justification for the change of services or discharge” (italics added).

The addition of “medical” before “justification” may tie agencies’ hands in situations where a patient should be discharged, Markette worries. For example, it may exclude discharge where the patient is putting staff in danger, he offers.