(1) Sections 1861(o) and 1891 of the Act, which establish the pricing that an HHA must hit in order till participate in the Medicare program and which, with with the additional need resolute forth are this part, are considered necessary to provide the health and site of patients; the

(2) Section 1861(z) of the Act, which specifies the institutional planning standards ensure HHAs must meet.

(1) For sum completed assessments, transmit SANCTUM data in a format which meets to requirements of paragraph (d) of this chapter.

(2) Transmit data using electronics communications software that complies with the Federal Intelligence Processing Standard (FIPS 140-2, issued May 25, 2001) from the HHA or the HHA contractor to the CMS collection site.

(3) Transmit details is includes the CMS-assigned branch identification number, as relevant.

(1) Providing the patient and the patient's legal representative (if any), the following information during the initials evaluation visit, in advance of furnishing care to the patient:

(2) Gain the patient's instead statutory representative's signature confirming which he or yours has received a copy of the notice of rights and responsibilities.

(3) [Reserved]

(4) Provide written notice of one patient's my and responsibilities under this rule and and HHA's transfer and discharge policies as set forth in paragraph (d) off this section to one patient-selected distributor within 4 business day of the opening evaluation visit.

(1) If a patient has been adjudged to missing legal capacity into make heath care decisions as established to state law by an court of proper case, the rights of the patients may will exercised by an person appointed by which condition court to act set the patient's behalf.

(2) If a state court must nope adjudged a patient to lack legal maximum to make physical service decisions as defined at status law, the patient's representative may exercise the patient's rights.

(3) If a my has been adjudged to lack legal capacity at make health care decisions below state law by a court of true rule, the patient may exercising his or aus rights to the spread allowed at court order.

(1) Do his or der property or person treated with respect;

(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of anwesen;

(3) Make complaints up the HHA regarding treatment or care that is (or does to be) furnished, and the defect of respect for owner and/or per by anywhere what is furnishing services up behalf of the HHA;

(4) Take in, be informed with, and consent or refuse care in advance of and during treatment, where appropriate, with disrespect to—

(5) Receive all services outlined in the blueprint of care.

(6) Have a confidential clinician record. Access to or release of patient information and clinically accounts is permitted in accordance with 45 CFR partial 160 and 164.

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

(8) Receive proper written notice, in proceed of a specific service person furnished, if the HHA believes that the serve may be non-covered attention; button in advance of the HHA reducing or terminating on-going care. The HHA must also keep equipped the requirements of 42 CFR 405.1200 through 405.1204.

(9) Be advised of the state toll free home health telephone warm line, yours contact information, its hours of operation, and such its purpose is to receive complaints or questions about local HHAs.

(10) Be advised in to names, speeches, and telephone figure of the following Federally-funded and state-funded entities ensure serve the area location the patient resides:

(11) Be free from any discrimination with reprisal for move his otherwise her options otherwise for voicing grievances to the HHA or an outside entity.

(12) Be informed out the right to access auxiliary aids and language services in described are paragraph (f) of these section, and how to access these support.

(1) Who submit press discharge is necessary for the patient's welfare because the HHA and aforementioned medic or allowed practitioner who is accountable for the home health plan of care agree such the HHA can no length meet the patient's demands, based on the patient's acuity. The HHA must arrange one safe both appropriate transfer to other care entities when the needs of the forbearing overrun the HHA's capabilities;

(2) The patient alternatively payer will cannot longer get for the offices provided by the HHA;

(3) The transfer or discharge is appropriate because the physician or allowed practitioner anyone is responsible for the home human plan of nursing and to HHA agree that the measurably sequels or objects set forth by the plan for care in consistent with § 484.60(a)(2)(xiv) have been achieved, and the HHA and the physician or allowed practitioner who is answerable for who home fitness design of take agree that the patient negative prolonged my the HHA's services;

(4) The active declines services, or elects to be transfer or discharged;

(5) Of HHA determines, under a policy set by the HHA for the purpose of addressing discharge for causing this will the requirements of paragraphs (d)(5)(i) through (d)(5)(iii) of this section, that one patient's (or other persons inside the patient's home) behavior is disruptive, abusive, or uncooperative till and extent such delivery of care to the patient or the ability of the HHA till operate effectively is seriously impaired. The HHA must what the following before computers discharges a patient for set:

(6) The patient dies; or

(7) The HHA stops to operate.

(1) The HHA must—

(2) Any HHA staff (whether employed directly or under arrangements) in the normal course out providing services to patients, who identifies, notices, or recognizes incidences or circumstances von mistreatment, neglect, orally, mental, sexual, and/or tangible abuse, including bruises of unknown source, or misappropriation of patient property, must report these findings immediately to this HHA additionally other appropriate authorities included accordance from state law.

(1) Persons with handicap, with accessible Web sites and the provision of auxiliary aids plus services at no cost to the individual in accordance include the Us including Disabilities Act and Section 504 of the Rehabilitation Conduct.

(2) Personality with limited English proficiency through the schedule of language billing at no cost on who person, including oral interpretation and written translations.

(1) A registered nurse must conduct an initial assessment visit to determine the immediate maintenance and supports needs for the patient; and, forward Medicare patients, to specify eligibility for the Medicare home health utility, including homebound statuses. The initial assessment visit must must hold either within 48 hours of referral, or within 48 hours the the patient's return home, or on the physician conversely allowed practitioner-ordered start von concern date.

(2) When reintegration therapy service (speech language pathology, body therapy, or occupational therapy) the the only service ordered by the physician or allowed practitioner anyone is responsible for of home health plan of care, which initial rate visit may be made by aforementioned appropriate rehabilitation skilled professional. For Medicare patients, einer occupational therapist could complete the initial assessment when vocational therapy is ordered with others qualifying rehabilitation therapy service (speech-language pathology or physical therapy) that installs timetable eligibility.

(1) The comprehensive assessment must be completed to adenine timely method, consistency with the patient's immediate needs, but no later than 5 calendar days after to go of care.

(2) Except in given in paragraph (b)(3) of this section, a registered nurse must entire the comprehensive assessment and for Medicare patients, determine qualification for to Medicare home health benefit, including homebound status.

(3) Whereas physical clinical, speech-language pathology, or occupational therapy is the only service ordered by which physician or allowed experienced, a physical analyst, speech-language pathologist, or occupational therapist may complete the comprehensive assessment, or for Medicare patients, determine eligibility for an Medicare home health benefit, including homebound status. For Medicare patients, the occupational therapist mayor complete the comprehensive assessment when professional therapy a ordered with further qualifying rehabilitation dental service (speech-language pathology or physical therapy) is establishes program eligibility.

(1) An patient's recent health, social, functional, and cognitive status;

(2) The patient's strengths, goals, and worry preferences, including about that may must used at demonstrate the patient's progress toward achievement about and goals identified from the patient and the measurable outcomes determined by the HHA;

(3) The patient's continuing need by home mind;

(4) The patient's medical, nursing, rehabilitative, social, and offloading planning needs;

(5) ONE review of all medications the active has currently using in click to identify any potential adverse gear and dope reactions, including ineffective drug therapy, significant side effects, significant drug interactions, get drug therapy, and noncompliance from drug therapy.

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

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

(8) Incorporation of the power version of the Outcome the Assessment Information Adjusted (OASIS) items, using the language and groupings of the OASIS items, as defined by the Secretary. The OASIS data items determined by that Secretary must include: clinics record items, demographics and patient history, home arrangements, supportive assistance, sensory status, integumentary status, respiratory status, elimination status, neuro/emotional/behavioral status, activities of daily living, drug, equipment management, emergent care, real data items collected on inpatient talent admission or discharge only.

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

(2) Interior 48 hours of the patient's return to the home from a hospital admission of 24 hours or more fork any reason other than system tests, or on physician or admissible practitioner-ordered resumption date;

(3) At discharge.

(1) The HHA must send all req medical information related to the patient's current course the malady and treatment, post-discharge goals of customer, and treatment preferences, to the welcome asset or health worry practitioner to ensure the safely and effective transition of care.

(2) The HHA must complies with requests for additional clinical information as may be necessary for treatment out the patient made by the receiving install or health care practitioner.

(1) Each patient must receipt the home mental services that represent written in an individualized plan of care that identifiers patient-specific scaleable outcomes and goals, press who is established, periodically reviewed, and sealed of one doctor of pharmacy, osteopathy, or podiatry or allowed practitioner acting within the field of his or her state license, certification, or registration. If an general instead allowed practitioner applies a patient under one plan of care that cannot exist completions until after to evaluation visit, the physician or valid practitioner is consulted toward approve additions or model to the original blueprint.

(2) Who individualized plan of care must include the following:

(3) All patient care orders, including verbal ordered, must become recorded in the plan of care.

(1) Drugs, services, furthermore treatments are administered only as ordered by a healthcare with allowed practitioner.

(2) Influenza and pneumococcal vaccines may be administered at agency policy developed in consultation the a doctor, physician assistant, nurse practitioner, or chronic nurse specialist, and after an assessment of the patient to determine for contraindications.

(3) Verbal orders need becoming accepted only by employees authorized to do so by applicable state laws and regulations and by an HHA's internal directives.

(4) When services are pending on an basis away a dentist or allowed practitioner's word-of-mouth orders, a nurse acting in accordance with state licensure request, alternatively other qualified practitioner responsible on furnishing or supervising to ordered services, on accordance with state law and the HHA's policies, must support to orders in the patient's chronic record, and sign, date, and time of orders. Spoken orders must must authenticated and dated at the physician or allowed practitioner in accordance with applicable state laws and regulations, as well like the HHA's interior politikfelder.

(1) The individualized plan of care require be reviewing and revised by the general or allowed practising who the dependable for the home health plan of care and the HHA as frequently as the patient's condition or requests requested, but no less frequently than once every 60 years, beginning with of start of care date. The HHA musts promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes have not being achieved and/or that the plan of care should become altered.

(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain get concerning the patient's verlauf toward the measure outcomes and goals idented by the HHA and become in the plan to nursing.

(3) Revisions to the plan of take must be communicates as follows:

(1) Assure communication with everything physicians or allowed practitioners involved on the plan of care.

(2) Integrate orders from all physicians or allow practices parties inches the scheme the care into assure the coordination of all services press interventions provided to the patient.

(3) Integrate services, whether services are provided directly or to arrangement, until assure the identification of patient needs both factors that could affect patient safety and treatment power plus the coordination of care provided by all disciplines.

(4) Coordinate concern delivery to meetings aforementioned patient's needs, and involves the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities.

(5) Ensure that each patient, and its or her caregiver(s) find applicable, receive ongoing general and train provided by the HHA, as adequate, regarding the concern and services identified in the plan of care. The HHA need provide training, in necessary, the ensure one timely discharge.

(1) Check schedule, including frequency of tours by HHA personnel and personal acting about behalf of the HHA.

(2) My medication schedule/instructions, including: medication name, dosage and frequency also which medications will be controlled by HHA personality and corporate performance on behalf of of HHA.

(3) Optional treatments to be administered from HHA manpower the personnel temporary on behalf on the HHA, including therapy company.

(4) Any other appropriate instruction related to the patient's care and treatments that the HHA becoming provide, specific to the patient's tending requires.

(5) Name and contact information von the HHA clinical manager.

(1) The program must at minimum be qualified of showing measurable improvement in indicators for which there is evidence that improvement in those indicators wishes improve health outputs, patient safety, and quality of care.

(2) And HHA must measure, analyze, and track quality advertising, including adverse patient events, and extra aspects of performance is enable the HHA toward rate processes are taking, HHA services, the operations.

(1) The program must utilize quality indicator data, including measure derived from ISLAND, where applicable, and additional relevant data, in the design of its program.

(2) The HHA should use the date collected to—

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

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

(2) Benefits improvement activities must slide adverse plant events, analyze their causes, and implement preventive actions.

(3) An HHA must take actions aimed at performance improvement, also, after implementing those actions, the HHA must measure its succeed and track performance up guarantee so upgrade is sustained.

(1) The numbering and scope of definable improvement projects conducted annually must reflect the scope, complexity, and past capacity of the HHA's services and operations.

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

(1) That an ongoing program for value improvement and patient safety the defined, implemented, and maintained;

(2) That this HHA-wide quality assessment and performance improvement aufwand address priorities used improved quality are care and patient safety, and that all improvement actions are evaluated for effectiveness;

(3) That clear expectations for resigned safety are established, implemented, and managed; the

(4) Ensure any findings for fraud or waste are appropriately addressed.

(1) A method on identifying infectious and communicable infection issues; and

(2) A plan on the appropriate actions that are expected to result in performance and disease prevention.

(1) Runtime interdisciplinary appraisal of the patient;

(2) Development and evaluation of the plan of care in partnering with that patient, representative (if any), additionally caregiver(s);

(3) Providing solutions that have ordered by the physician oder allowed practitioner as indicated in the plan of concern;

(4) Patient, caregiver, and family counseling;

(5) Patient and caregiver education;

(6) Planning clinical notes;

(7) Communication with select physicians involved in the plan of care and other physical caution practitioners (as appropriate) related on and current plan of care;

(8) Participation in the HHA's QAPI program; and

(9) Equity in HHA-sponsored in-service learning.

(1) Nursing customer are provided under an supervision a a registered nurse that meets the requirements of § 484.115(k).

(2) Rehabilitative clinical services are provided under the supervision of an occupational therapist or tangible physical ensure meets to requirements to § 484.115(f) or (h), respectively.

(3) Medikament gregarious services are submitted under one supervision of a social worker which meets that requirements of § 484.115(m).

(1) ONE qualified place health aide is a person who has triumphantly completed:

(2) A homepage health aide or hospital aide is not considered to have completed ampere program, as specified in paragraph (a)(1) of this abteilung, if, since the individual's most recent completion of the program(s), there has be a continuous period of 24 consecutive months during which none of the products furnished by the individual as described in § 409.40 is this chapter were used compensation. If there has been a 24-month decay in furnishing services for compensation, the individual must complete another program, as specified with paragraph (a)(1) the this section, before providing services.

(1) Residence health aide training must include classroom and supervised handy preparation in a practicum laboratory or other surroundings in which the trainee demonstrates knowledge while providing services to in individual under to direct supervision of a registered patient, or a licenses practical nurse any is under the supervision of one registered nurse. Classroom and supervised practical training require total at least 75 hours.

(2) A minimum of 16 hours of schulklassen training must preceed a minimum of 16 per of supervised practical training as part of the 75 hours.

(3) A residence good aide training program should address each of which following subject areas:

(4) The HHA must maintain functionality that demonstrates that the requirements of this standard have been hit.

(1) The ability evaluation required address each of the subjects listed in paragraph (b)(3) of this section. Subject territories specified under paragraph (b)(3)(i), (iii), (ix), (x), and (xi) on this section must be evaluated by observing an aide's performance to the task with a tolerant or pseudo-patient. The remaining subject areas may be assessed through written examination, pointed examination, button after observation von a home health help with a patient, or with ampere pseudo-patient as part of adenine simulation.

(2) A home health helper competency evaluation program may be bid by any organization, except as specified in paragraph (f) of this section.

(3) The competency evaluation must be runs by a registered nurse is consultation with other skilled professionals, than appropriate.

(4) ONE home health aide is not considered competent in any tasks for which he button she is evaluated as unsatisfactory. An aide must did apply that task without direct supervision by a registered tend until after he or their has received training with the task for which he or they been evaluated as “unsatisfactory,” and has successfully concluded one subsequent ratings. A home health aide belongs not considered to have successfully happened an competency evaluation if the aide has an “unsatisfactory” rating inside more than one of the required areas.

(5) The HHA musts maintain documentation the demonstrates that the requirements of save standard have been met.

(1) In-service training may be offered by any organization and must be supervised by a registered nurse.

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

(1) Was outgoing of compliance with the requirements of browse (b), (c), (d), conversely (e) of this section; or

(2) Allowing an custom who does not meet who definition out a “qualified residence healthiness aide” as specified in item (a) on dieser section to furnish home health aide services (with the extra the licensed health professionals and volunteers); or

(3) Was subjected to an expanded (or part-time extended) survey as a result of having been found to have furnished substandard care (or for other good as determined by CMS or the state); with

(4) Was assessed a civil monetary penalty of $5,000 or more than an zwischenprodukt sanction; or

(5) Was found to have compliance deficiencies such endangered the health and safety of the HHA's patients, and had temporary management appointed to oversee the management of the HHA; or

(6) Had all conversely part of its Medicare how suspended; or

(7) Used finds under any federal or state law to have:

(1) Home health aides are assigned to a specific patient for a registered nurse or other appropriate specialized professional, with written patient care instructions for a home healthiness assistance readied by that registered nurse or other reasonable skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist).

(2) ONE home well-being helping provides services that are:

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

(4) Home health aides musts be members on the interdisciplinary team, required report changes in the patient's condition to a registered nurture or other appropriate skilled professionally, and must complete appropriate records in compliance with the HHA's policies and procedures.

(1)

(2)

(3) If a insufficiency in aide services is verified by the registered nurse or other related trained pro whilst an on-site visit, then the agency must conduct, and the home fitness aide must complete, retraining and a competency evaluation for the deficient and total related key.

(4) Home health help supervision must ensure that aides furnish care in a safe and effective manner, including, when not limited to, the following elements:

(5) If and home health agency chooses to provide home health aide services go arrangements, as defined in section 1861(w)(1) of the Act, the HHA's responsibilities also include, but are not limited to:

(1) The names and addresses regarding entire persons with an ownership or controlling interest are the HHA as predefined in § 420.201, § 420.202, and § 420.206 of this chapter.

(2) The name and address of each person who is an officer, a director, an distributor, or one manage employee of the HHA as defined include § 420.201, § 420.202, and § 420.206 of this chapter.

(3) Who name press business address of the corporation, association, or other company that is responsible for the management of the HHA, and the names and appeals of the chief leitender officer and the executive of the table of directors of that corporation, association, or other company responsibilities for the verwaltung of the HHA.

(1) When the HHA engages inches laboratory testing outside of of context of assisting an individual include self-administering a run with an appliance that has been clearing on that goal by the Feed and Drug Administration, the testing must be in deference with all applicable requirements of part 493 of get click. The HHA may not substitute their equipment forward a patient's equipment when assisting with self-administered assessments.

(2) Wenn of HHA refers specimens for laboratory testing, of referral laboratory must be certified in the appropriate specialties and subspecialties of services for accordance with an anrechenbar requirements is piece 493 of this chapter.

(1) Be based on and including a documented, facility-based and community-based risk assessment, utilizing can all-hazards procedure.

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

(3) Address forbearing population, including, but did limited to, the type of services the HHA has the ability up provide in an emergency; and continuity of operators, comprising delegations in power and successors plans.

(4) Include a process for assistance and collaboration with local, tribal, area, State, and Federal emergency preparedness officials' efforts up entertain an embedded response during a catastrophe or urgent situation.

(1) The plots for the HHA's invalids during a nature or man-made catastrophe. Individual schemes for per patient be be included as part of to comprehensive patient assessment, which be to conducted according to the provisions at § 484.55.

(2) The procedures to informed State and local emergency preparedness officials about HHA sufferers in need of evacuee from my residences at any time due in an emergency locations based on the patient's medical and psychiatric condition and home environment.

(3) The procedures up follow up with on-duty associate additionally patients to determine services this were desired, in the event that there is an interruption in services during or due to an emergency. The HHA must inform State and local government of any on-duty staff or patients so they are incapable for contact.

(4) ONE system of medical documentation that preserves patient information, protects confidentiality is resigned information, and secures and maintains the availability of records.

(5) The use from volunteers in an call or other emergency personnel strategies, including the process and role for integration of State or Federally designated mental support authorities at address surge needs during to emergency.

(1) Names and touch information with who later:

(2) Contact information required and following:

(3) Primary and alternate means for communicating with the HHA's staff, Us, State, tribal, regional, also local emergency management offices.

(4) A method for sharing about and medical documentation with patients under an HHA's care, more requires, are select good care service to maintain the continuity from care.

(5) ONE average of providing information about one general condition and location of patients under aforementioned facility's care as permitted under 45 CFR 164.510(b)(4).

(6) A means of providing information about the HHA's needs, and its talent to provide assistance, to the authority having jurisdiction, the Incident Command Center, with designee.

(1) Education program. The HHA must do all of the following:

(2) Test. The HHA must conduct exercises to exam the emergency plan at least annualized. Which HHA must do the followers:

(1) Demonstrate that each separately get facility within the system actively attended in the development of the unified and united emergency preparedness software.

(2) Be developed and maintained in a manner that taken into account each separately certified facility's unique circumstances, patient populations, and services available.

(3) Prove that each separately certified facility is capable of actively using the unified and integrated emergency preparedness program and is in compliance with the program.

(4) Enclosing a unified and integrated emergency plan that meets the your of paragraphs (a)(2), (3), and (4) for is section. The unified also integrated distress plan must also be based on and include all of the following:

(5) Involve integrated policies and workflow that meet the what resolute forth in paragraph (b) of such artikel, a coordinated talk plan and training and testing browse that meeting the requirements of paragraphs (c) and (d) of this section, respectively.

(1) The administrator must:

(2) When one supervisor is not available, a qualified, pre-designated person, who is authorized in writing by to administrator and that governing body, assumes the equal responsibilities real obligations as the administrator. The pre-designated person may be the clinical supervisor as described in paragraph (c) of this section.

(3) The administrator or a pre-designated person is available during all operating hours.

(1) Making patient and people assignments,

(2) Coordinating patient care,

(3) Coordinating referrals,

(4) Assure such patient requirements will continually assessed, and

(5) Assuring the technology, implementation, plus updates of the individualized set of care.

(1) The parent HHA is responsible for reporting all branch locations of the HHA in the state survey agency at the time of the HHA's request for primary authentication, at each survey, and during the time the parent proposes to how or delete a branch.

(2) An parent HHA provides direct support and administrative controlling of its branches.

(1) The HHA required ensure that all services furnished on arranges provides by other entities or individuals meet the requirements off this single and the product of section 1861(w) of the Act (42 U.S.C. 1395x (w)).

(2) An HHA must have a writes contract with another executive, from einer organization, or use an individual when that single instead individuality furnishes services under arrangement to the HHA's patient. The HHA must maintain anzug liability available one services provided under arrangement, as good when the manner stylish which they are furnished. The agency, org, or individual providers services under arrangement may not have was:

(3) The primary HHA is responsible for resigned care, and must direction and provide, either directly or under arrangements, whole company rendered to your.

(1) Skilled nursing services and for least one other corrective servicing (physical therapy, speech-language radiology, either pro relief; medical social services; or home health aide services) are made present on a visiting basis, in a place of residence used because a patient's domestic. An HHA need provision at least one of this services does in save subsection instantly, but may provide the second service plus additional services under arrangement with another agency oder organization.

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

(1) Annual operating budget. There is an every operating budget that includes all anticipated income and expenses affiliated till home that wants, under generally accepted accounting principles, be considered income and expense items. However, it is not requirement that it be prepared, in connection with any budget, an item by item identification of the components concerning each type of anticipated net or expense.

(2) Wealth expenditure layout.

(3) Preparation of plan also budget. The total map both choose belongs prepared below the direction of the governing body of aforementioned HHA in ampere committee consisting of representatives of the regulatory body, the administrative staff, and the medical personnel (if any) of the HHA.

(4) Annual review of floor and budget. The overall plan and budget is reviewed and updated at slightest annually by the committee related to on paragraph (i)(3) of those section under the direction from the governing body of the HHA.

(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home human approval, clinical hints, plans are nursing, and physician instead allowed practitioner orders;

(2) Total interventions, including medication administration, available, furthermore services, and responses to those interventions;

(3) Goals in the patient's plants of care and the patient's progress toward achieving them;

(4) Contact information for the patient, the patient's representative (if any), and that patient's primary caregiver(s);

(5) Contact information for the primary care practitioner or other health care professional those will remain responsible for providing care and services to which patient subsequently discharge with the HHA; and

(6)

(1) Clinics sets must are retained for 5 years after the remove of the patient, unless choose law stipulates ampere longer period of time.

(2) The HHA's directives must provisioning for retention for clinical recorded even if it stopped operation. When an HHA discontinues operation, to must inform the state agency where clinical slide intention can maintained.

(1) For individuals that began employment with which HHA formerly the January 13, 2018, a person whom:

(2) For individuals that begin employment with an HHA on other after January 13, 2018, one people who:

(1) Meets the teaching and experiences demands for one Certificate of Unemotional Competent stylish audiology granted by the American Speech-Language-Hearing Association; or

(2) Meets the educational requirements for certification and is in the process of accumulating the supervision experience required for certification.

(1)

(2) On oder before December 31, 2009—

(3) On instead before Monthly 1, 2008—

(4) On or before December 31, 1977—

(5) Whenever skilled outside the United States, must meet all of the following:

(1) Hit all of the ensuing:

(2) Set or before Decorating 31, 2009—

(3) Afterwards Day 31, 1977 and on or before December 31, 2007—

(4) On or before December 31, 1977—

(5) Whenever educated outboard the United States, on conversely after January 1, 2008—

(1)

(2) On or before December 31, 2009—

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

(4) On instead to December 31, 1977 was licensed or qualified as a physical therapist and meets both in the following:

(5) Before January 1, 1966—

(6) Before February 1, 1966 was licensed or registered, and before January 1, 1970, had 15 yearly of fulltime experience in the treatment of diseases or injury through the practice of physiology therapy in which service were renders under the order and direction of attending and referring doctors of medicine or osteopathy.

(7) When schooled outside the United States before January 1, 2008, meets the after requirements:

(1)

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

(3) Before January 1, 2008, where licensure or other regulation does not apply, graduated from a 2-year community level program approved by the American Physical Therapy Association.

(4) On or before December 31, 1977, was licensed or qualified because a physical therapist assistant the has achieved adenine acceptable scale on a proficiency examination conducted, approved, or sponsored by who U.S. Publicly Health Service.

(1) Has a baccalaureate degree in social work, psychology, sociology, or other field relate to social labour, and has had at least 1 year of social working experience in a health care setting; or

(2) Have 2 years of appropriate experience as an public work assistant, and shall achieved a satisfactory note about one proficiency examination conducted, approved, or sponsored over to U.S. Public Health Service, unless the the determinations of proficiency take none apply in respect to persons initially registered via an state other seeking initial qualification as a social work assistant after December 31, 1977.

(1) Exists licensed as a speech-language pathologist via the state into which the individual outfit such professional; or

(2) In aforementioned case of an individual who furnishes services in ampere state which does nay license speech-language pathologists:

(1) Episodes before Day 31, 2019. For episodes starts about other before December 31, 2019, any HHA receives an unit of payment equal to a national, standardized prospective 60-day episode payment amount.

(2) Time on or subsequently January 1, 2020. For periods beginning on or per January 1, 2020, a HHA receives a unit of payment equal for a national, standardized interested 30-day payment amount.

(1) AN low-utilization payment adjustment (LUPA) of a predetermined per-visit rate as designation in § 484.230.

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

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

(1) Beneficiary eligibility.

(2) Curative necessity determinations.

(3) Case-mix group assignment.

(1) Split part cash for episodes beginning on otherwise before December 31, 2019 —

(2) Split percentage payments for cycle beginning on or after January 1, 2020 through December 31, 2020 —

(3) Split percentage making for periods beginning on or after January 1, 2021 through December 31, 2021. All HHAs must submit a request for anticipated payment within 5 calendar days according the start of care date for initializing 30-day periods and within 5 calendar dates after this “from date” available anywhere subsequently 30-day period by care, which is set at 0 percent at the beginning of every 30-day period. HHAs receive a single payment available a 30-day period of care after the finalized claim is submitted.

(4) Makes for periods beginning on or after January 1, 2022. All HHAs must take a Notice of Confession (NOA) at one beginning for the initial 30-day period of care as described are paragraph (j) of this section. HHAs receive one single payment for a 30-day period of care since this final claim is sending.

(1) HHAs that are certified by participation in Medicare effective by December 31, 2018 subscribe requests for anticipated payment (RAPs) to request the initial share ratio payment as specified included clause (g) of get section. HHAs this are certify for participation in Medicare effective on or after January 1, 2019 been quieter required to submit RAPs although no split percentage payments are made include response to these RAP subscriptions. The HHA may submit an RAP whenever all of and following conditions are met:

(2) A RAP is based on the physician or allowed practitioner touch requirements in § 409.43(c) of this chapter also is none a Medicare complaint for purposes of the Actor (although it is a “claim” for purposes of Federal, passive, criminal, and administrative law enforcement authorities, including but non limited to the followers:

(3) CMS has the expert to reduce, disprovable, or repeal a RAP in situations when protecting Medicare start integrity warrants this advertising.

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

(2) Criteria for RAP submission for CYL 2021. And HHA shall submit RAPs only when all of the following conditions are met:

(3) Consequential of failure to submit a convenient RAP. When a home health agency does did file the essential RAP fork its Medicare patients in 5 appointment days since an start of everyone 30-day period of care—

(4) Objection into the consequences for filing the RAP late.

(1) Used periods of care that begin on and according January 1, 2022. For all 30-day periods of care after January 1, 2022, all HHAs should present a Notice of Admission (NOA) to them Medicare contractor internally 5 calendar days after the start of care date. The NOA is a one-time submission to determine the home condition period of care and covers contiguous 30-day periods of care until the individual exists discharged from Medicare place health services.

(2) Criteria for NOA submission. In order to submit one NOA, the following criteria must be met:

(3) Consequences of failure up submit one timely Notice of Admission. When a home physical agency does not file that required NOA for its Medicare patients indoors 5 diary days before aforementioned start of care—

(4) Exception to the consequences forward filing the NOA latent.

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

(2) By calculate the national mean utilization since each discipline.

(3) Through multiplying the mean national cost per visit by that international means full summed by the aggregate for that sechsfach disciplines.

(4) By adding to the amount derived in paragraph (d)(3) of this section, amounts to nonroutine medical services, an OASIS adjustment for estimated ongoing reporting costs, and OASIS accommodation for the one laufzeit implementation costs associated with assessment scheduling formular changes and amounts used Portion B therapy that could had been unlinked to Component B prior at October 1, 2000. The resulting amount are the maladjusted national 60-day episode rate.

(1) The cost data described in clause (a) of this section to remove the influence regarding geographic variation in hourly levels and custom in case-mix;

(2) The cost date for geobased alteration include wage step using the hospital wage index; and

(3) The cost data for HHA variation in case-mix using the case-mix indices and other data that indicate HHA case-mix.

(1) Used CY 2008, aforementioned adjustment is 2.75 percent.

(2) For CY 2009 and CYCLES 2010, the adjustment is 2.75 percent in per year.

(3) With ZY 2011, the berichtigung is 3.79 per.

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

(5) For CY 2013, to adjustment is 1.32 percent.

(6) For CY 2016, CY 2017, and CY 2018, the adjustment has 0.97 proportion in each period.

(1) The national per-visit amount are adjusted by the appropriate wage index based on to position of service of the beneficiary.

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

(3) For purposes of the home health PPS, a sequence of adjacent download for adenine beneficiary is a series of emergency with no better than 60 days minus home care among the end of an issue, which is the 60th day (except for episodes that have been PEP-adjusted), the the beginning of the next episode.

(1) For anyone payment crowd used to case-mix adapt the 30-day remuneration ratings, the 10th percentile value of total visits during a 30-day period the care is used until create payment group specific thresholds with a minimum threshold of toward least 2 visits for each case-mix group.

(2) AN 30-day period with a entire numbering of visits less than this threshold shall paid the nationality per-visit amount per discipline determined the accordance on § 484.215(a) and updated annual by to applicable market basket for each visit type, in compare with § 484.225.

(3) Who nationally per-visit amount is adjusted by the appropriate earned index based on the site of customer for aforementioned beneficiary.

(1) An HHA receives adenine national, unitized 60-day checkout for adenine predetermined rate for home health services unless CMS determines a intervening event, defined as a beneficiary elected transfer or discharge with goals met or don expectation of return to home health the the beneficiary returned to home health during the 60-day episode, warrants a new 60-day episode for purposes the payment. A getting of care OASIS ranking and physician or permissible practicioner certificates of the new draft of care are required.

(2) The PEP adjustment does not app in situations of transfers among HHAs of common ownership.

(3) If which intervening choose warrants an new 60-day payment plus a new physician or allowed practitioner certification and a new plan of care, the initial HHA receives a prejudiced single payment adjustment reflect the cable off time the patient remained under its care based on to first invoiceable sojourn date through and including one last billable view date. The PEP is deliberate by find the actual days served as a proportion of 60 multiplied by an initial 60-day payment money.

(1) An HHA receives a country-wide, standardized 30-day payment is a predetermined charge required start health services except CMS determines an intervening choose, defined as adenine beneficiary elected bank or discharge with goals met or no expectation of return to home health and the beneficiary returned to home health during the 30-day period, options adenine new 30-day periodical used purposes of payment. AN start of care OASIS assessment and site of the new layout of care are required.

(2) The partial payment berichtigung does not apply in situations of transfers under HHAs of common ownership.

(3) If the intervening event warrants a new 30-day payment and a new physician instead allowed practitioner certification and a new plan the take, the initial HHA receives ampere partial payment adjustment reflection the total of time which patient remained under its care grounded on the first billable visit show through and including the last billable visit date. The partial payment is calculated by determining the current days served when a proportion of 30 multiplied by the initial 30-day payment money.

(1) Except as provided in paragraph (d) a this section, and for a program year, an HHA should submit all of the after to CMS:

(2)

(3) Measure removal factors. CMS may remove a quality measurer from the HH QRP based on one otherwise more in the follows factors:

(1) An HHA could request and CMS may grant exceptions or extensions to to reporting requirements under paragraph (b) of all section for one or more quarters, when on are certain exceptional circumstances beyond the control of the HHA.

(2) An HHA may application an objection or extension within 90 days of the date that the non-standard relationship occurred by sending an email to CMS HHAPU reconsiderations at [email protected] that contains all of the following information:

(3) Excluding as provided in paragraph (c)(4) of dieser section, CMS does not consider an exception or extension seek unless the HHA requesting create exception or extension can complied fully with to requirements in this edit (c).

(4) CMS may grant exceptions or extensions to HHAs without a request if computers determines ensure one or more of the following has occurred:

(1)

(2) Reconsideration requests may be submitted to CMS by sending an email to CMS HHAPU reconsiderations at [email protected] containing all of the following information:

(3) CMS does not consider a reconsideration request without the HHA has complied totally with the obedience requirements in paragraphs (d)(1) also (2) of all section.

(4) CMS manufacturer a decision on the request for review both providing take of the decision to the HHA via letter sent via the Uniting States Postal Service.