Articles

Regulatory Requirements of Home Health Care Agencies

By: Theodore M. McGinn

August 1, 2009

Every operator of a home health care agency in Illinois knows that they are required to obtain a license with the Illinois Department of Public Health. If they want to receive reimbursement through Medicare, there are additional certification steps. However, many agencies fail to understand what the regulations require of it in order to be compliant and operate under Illinois law.

All services shall be provided in accordance with the orders of the patient's physician, under a plan of treatment by that physician and under the supervision of agency staff. Contractual arrangements shall be through a written agreement which may include but is not limited to services to be provided, provisions for initial health evaluations and employee health policies, designation of full responsibility, charges, statement of responsibility, liability and insurance coverage, dates and signatures, and provisions for termination of service.

Prior to the acceptance of any patient, the agency shall inform the person of the agency's charges. Patients are accepted 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. Services shall not be terminated until such time as the registered nurse, or the appropriate therapist, or both, in consultation with the patient's physician, deem it appropriate or arrangements are made for continuing care.

Skilled nursing and other home health services shall be in accordance with a plan based on the patient's diagnosis and assessment of the patient's immediate and long-range needs and resources. The plan of treatment is established in consultation with the home health services team, which includes the patient's physician, pertinent members of the agency staff, the patient, and members of the patient's family. The plan of treatment shall range from diagnoses, regimen of medications, treatments, and instructions for a timely discharge. Any and all changed to the plan shall be documented and signed by said physician.

Home health services from members of the agency staff, as well as those under contractual arrangements, shall be provided in accordance with the plan of treatment and the patient care plan. The patient care plan shall be written by appropriate members of the home health services team based upon the plan of treatment and an assessment of the patient's needs, resources, family and environment. The initial assessment is to be made by a registered nurse. The plan shall be maintained as a permanent part of the patient's record. The patient care plan shall indicate patient problems and goals, service approaches to modify or eliminate problems, staff responsible for each element of service, anticipated outcome and estimated time for completion and potential discharge.

Each agency shall have a written policy on records procedures and shall retain records for a minimum of five years beyond the last date of service provided. If the professional is providing services through a contract with the agency, then the contract shall include that the professional shall maintain the original records for a period of five years. Each agency shall have a written policy and procedure for the protection of confidentiality of patient records that explains the use of records, removal of records and release of information.

The home health agency shall have written policies and shall make an overall evaluation of the agency's total program at least once a year. This evaluation shall be made by the Professional Advisory Group (or a committee of this group), home health agency staff, consumers, or representation from professional disciplines that are participating in the provision of home health services. The data to be considered may include the number of patients receiving each service offered, number of patient visits, reasons for discharge, breakdown by diagnosis, sources of referral, number of patients not accepted, with reasons, and total staff days for each service offered.

At least quarterly, members of professional disciplines representing at least the scope of the agency's programs shall review a sample of both active and closed clinical records to assure that established policies are followed in providing services. Clinical records shall be reviewed continually for each 62-day period that a patient received home health services to determine the adequacy of the plan of treatment and the appropriateness of continuing home health care.

Obtaining your licensure through the state of Illinois is only the initial requirement to be compliant under Illinois law. Once the license is granted, the agency must continue to operate within the confines of the regulations. Failure to follow the regulations could result in a failed survey and worse, termination of your license.