Home Health & Hospice Week

Final Interpretive Guidelines may not jibe with your state laws.

Some definition changes in the Interpretive Guidelines for the Home Health Conditions of Participation may trip up your compliance if you don’t know the ropes.

In the final IGs issued Aug. 31, the Centers for Medicare & Medicaid Services revamps and beefs up its “abuse” definitions under Tag G430: §484.50(c)(2) The patient has the right to be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property, as well as adding a new definition for “neglect.”

The change may lure home health agencies into thinking they are compliant with the CoP when they are not, warns attorney Robert Markette Jr. with Hall Render in Indianapolis. The new IG definitions may be broader than the ones HHAs are used to under state law, so their compliance with that state law may lead them to falsely believe they are also in compliance with the HH CoPs that took effect in January.

“Be ready for it,” Markette says of surveyor scrutiny on this requirement.

This danger is particularly present in the new “neglect” definition, which CMS defines as “a failure to provide goods and/or services necessary to avoid physical harm, mental anguish or mental illness.”

“How are agencies supposed to gauge this?”  Markette asks of the “broad” definition. “Is a difference of opinion on the Plan of Care neglect?”

Take a look at the changes:

Draft IG: “The patient has a right to be free from abuse from the HHA staff and others in their home environment. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.

“Misappropriation of property is theft or stealing of items from a patient’s home. The HHA staff must investigate and take immediate action on any allegations of misappropriation of patient property by HHA staff and refer to authorities when appropriate.

“Verbal abuse refers to any use of insulting, demeaning, disrespectful, oral, written or gestured language directed towards and in the presence of the client.

“Mental abuse includes, but is not limited to, humiliation, harassment, and threats of punishment or deprivation, sexual coercion and intimidation (e.g. living in fear in one’s own home). “Sexual abuse includes any incident where a beneficiary is coerced, manipulated, or forced to participate in any form of sexual activity for which they did not give affirmative permission (or gave affirmative permission without the understanding required to give permission) or sexual assault against a beneficiary who is unable to defend him/herself.

“Physical abuse refers to any action intended to cause physical harm or pain, trauma or bodily harm (e.g., hitting, slapping, punching, kicking, pinching, etc.). It includes the use of corporal punishment as well as the use of any restrictive, intrusive procedure to control inappropriate behavior for purposes of punishment.

“An injury of unknown source is: An injury that was not witnessed by any person and the source of the injury could not be explained by the patient.

The patient may experience normal day-to-day bumps and minor abrasions as they go about their lives. These minor occurrences should be recorded by the HHA staff once they are aware of them and follow-up should be conducted as indicated.”

Final IG: “The patient has a right to be free from abuse from the HHA staff and others in his or her home environment. The HHA should address any allegations or evidence of patient abuse to determine if immediate care is needed, a change in the plan of care is indicated, or if a referral to an appropriate agency is warranted. (State laws vary in the reporting requirements of abuse. HHAs should be knowledgeable of these laws and comply with the reporting requirements.) In addition, the HHA should intervene immediately if, as indicated by the circumstances, any injury is the result of an HHA staff member’s actions. The HHA should also immediately remove staff from patient care if there are allegations of misconduct related to abuse or misappropriation of property.

“‘Abuse’ means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse may be verbal, mental, sexual, or physical and includes abuse facilitated or enabled through the use of technology.”

The verbal, mental, sexual, physical abuse sections are pretty much the same between draft and final versions.

“‘Injury of unknown’ source is an injury that was not witnessed by any person and the source of the injury cannot be explained by the patient.”

The misappropriation definition is placed lower in the final than draft IG, but remains essentially the same between versions.

“Neglect means a failure to provide goods and/or services necessary to avoid physical harm, mental anguish or mental illness.”

Note: For information on the IG changes that benefit HHAs, see a future issue of Eli’s Home Care Week.