FREQUENTLY ASKED QUESTIONS

This page contains frequently asked questions about Maxim and Maxim’s
Compliance efforts.

1. How would you define a qualified person who can act in the absence of the administrator?
   
   42 CFR 484.4 states an administrator of the HHA is a person who “is a licensed physician, a registered nurse, or has training and experience in health service administration and at least one year of supervisory or administrative experience in home health care or related health programs”.
   
   A qualified person should have the same qualifications as the administrator, i.e. a RN or a physician, or a person with appropriate training and experience. In addition, according to 42 CFR 484.14(c) the qualified person must be authorized in writing to act in the absence of the administrator.
2. Can the HHA refuse to have the surveyor look at the agency’s complaint logs because the records contain risk management information?
   
   As part of the patient rights condition of participation (COP), the HHA is required to investigate complaints made by a patient or the patient’s family or guardian regarding treatment or care that is (or fails to be) furnished, and to document both the existence of the complaint and resolution of the complaint. Surveyors, as part of their investigation of the HHA’s compliance with this COP, may ask to review complaints received by the HHA and the resolution of these complaints. The HHA may not refuse to permit examination of these records by or on behalf of CMS without risking termination from the Medicare/ Medicaid or state funded program.
3. Is it permissible for an HHA to request that a patient sign a consent indicating he is aware that there is a limited amount of staffing available from the HHA?
   
   No. The HHA is required to accept patients for treatment on the basis of a reasonable expectation that the patient’s medical, nursing, and social needs can be met adequately by the agency in the patient’s place of residence. If the HHA is unable to provide the ordered care and services that the patient needs, it should not accept the patient for care. Providing less services than the physician orders would be a violation of the COP at 42 CFR 484.18. Asking the patient to sign a consent form indicating he is aware that there is a limited amount of staffing from the HHA does not release the HHA from its obligation to provide the needed services.
4. What are recommendations for “frequently” regarding Professional Advisory Board (PAB) involvement with reviewing “scope of services?” If the MD is not present did the PAB meetings officially occur?
   
   The term “frequently” is not defined in 42 CFR 484.14.16 (a), “Advisory and evaluation function.” “Frequently” should be defined within the agency’s policies and procedures. In addition, it must annually review the agency’s policies that govern services offered, admission and discharge policies, clinical records, program evaluation, etc. If the HHA’s policy states the professional advisory group meets three times a year, there should be evidence to support the meetings occurred. 42 CFR 484.16 requires the group to include at least one physician, one RN, and representation from other disciplines. If the physician did not participate during the meeting, then the meeting is not complete.
   
5. What type of information are the surveyors reviewing on the annual program evaluations? How can the agency present the information to the surveyor?
   
   42 CFR 484.16 (G153) describes information that is reviewed on annual evaluations. It includes a review of the agency’s policies governing scope of services offered, admission and discharge policies, medical supervision and plans of care, emergency care, clinical records, personnel qualifications, and program evaluation. The information may be presented in the format the agency deems most acceptable.
6. Can Physician Assistants (PA) sign the plan of care (POC) and does the duration for home health aide need to be specified on the POC?
   
   The PA may not sign the POC in lieu of the doctor in Medicare approved HHAs. Section 1861(m) of the Social Security Act specifically states that home health patients must be under a plan of care signed by a doctor. The doctor must also specify the frequency and expected duration of the visits for each discipline.
7. The plan of care requires the HHA to indicate the visit frequency for services provided to the patient. Does the initial visit have to be included in the frequency and can a visit be made every other week? This would cause some weeks to have a zero visit frequency.
   
   42 CFR 484.18 (a) describes the requirements for completing the POC. The initial visit needs to be included in the visit frequency for the first week. Visits are made according to patient needs and may be stated in days, weeks, or months (e.g. 3x/wk x4 wk or 1 x mo. x 2 mos). Visits may also be made every other week, and may be written as visits “every other week.”
8. 42 CFR 484.18 (a), G159, states the POC covers the patient’s pertinent diagnosis, services and equipment required, frequency of visits, prognosis, medications and treatments, and any other appropriate items. How does it pertain to patient’s goals? Is there another citation if goals and objectives are not specific and measurable?
   
   The plan of care requirement included a caveat for the addition of “any other appropriate items.” Goals should be included as part of the POC and are referenced in the regulation at 42 CFR 484.14 (g) which requires personnel who provide service to patients to coordinate their efforts and support the objectives outlined in the POC. Goals are stated as objectives.
9. How specific do modalities and procedures need to be to meet G161 – specific procedures and modalities to be used in orders for therapy services?
   
   Modalities must be specified by name, e.g., ultrasound, and must include time, frequency and duration of services, e.g., ultrasound for ten minutes twice a week for eight weeks. Procedures are broader in scope of and must include frequency and duration, e.g., dressing activities twice a week for four weeks.
10. The POC usually includes treatment specifics. If the POC does not include specifics for wound care (aseptic, sterile, or clean technique), can this be cited? Is it a failure to revise the POC?
    
    The above may be cited under G158, G160, and G173. G158 refers to failure to follow the written plan of care established by the physician. G160 refers to failure to consult with the physician to approve modifications to the original plan of care. G173 refers to the registered nurse’s failure to make revisions to the plan of care. The above example is a failure to revise the POC. The RN should contact the physician for specific orders on wound care.
11. How often do I have to check the refrigerator temperature?
    
    The CDC and vaccine manufactures require tight temperature controls for storing vaccines. The CDC provides a refrigerator log that has slots for recording the temperature twice a day. It is important to monitor your refrigerator temperature throughout the day as opening and closing the door will create temperature changes. Variations in the amount and placement of the vaccines in the refrigerator can also produce temperature variations.
12. How can the Director of Clinical Services or Clinical Supervisor prepare the staff nurse for a home visit by a compliance specialist or surveyor?
    
    Select a patient with skilled care needs unless otherwise directed and review the current plan of care and list of medications with the nurse primarily responsible for the care. Ensure that the nurse understands the diagnoses, plan of care, disease process, and policies related to nursing care for the patient. Remind the nurse not to complete all skilled care prior to the arrival of the surveyor(s) and obtain the most appropriate time for the surveyor to arrive to review the skilled care provided by the nurse.