Every finding on record at Apex Homecare Inc

A Recertification survey entrance was conducted on 8/22/23. Census: Licensed and Certified Home Health – 4

A Recertification survey entrance was conducted on 8/22/23. Census: Licensed and Certified Home Health – 4 Definitions: SOC- Start of Care POC – Plan of Care DC – discharge pt – patient RN – registered nurse ESRD - end stage renal disease NOMNC – Notice of Medicare Non-coverage (written notice to be delivered to Medicare patients before 2 days of Medicare coverage ending). BNI- Benefits Improvement and Protection Act (Medicare regulation to give beneficiaries access to expedited determination process when the patients home health services are ending). QIO – Quality Improvement Organization (the QIO contact phone number is to be included on the NOMNC. OMB – Office of Management and Budget (responsible for overseeing Federal agencies’ forms) OASIS- Outcome and Assessment Information Set (group of standard data elements home health agencies integrate into their comprehensive assessments to collect and report to CMS). CMS – Center for Medicare and Medicaid Services

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to deliver a completed copy of the NOMNC at least 2 days before the agency’s intent to discharge, in 1 Goals Met patient (Patient 1), of 3 discharge records reviewed. This failure prevented Patient 1 from receiving necessary Medicare guidance and QIO contact information regarding the patients right to appeal the discharge, after the agency’s notification to the patient of Medicare services ending. Findings include: “Regulation: July 1, 2005, the new Medicare regulations (Benefits Improvement and Protection Act) BNI gave beneficiaries access to the new expedited determination process when their home health services are ending. There are two notices required by these regulations. The first is the generic notice called the Notice of Medicare Provider Non-coverage (NOMNC) that the provider will deliver at least two days prior to when a beneficiary’s Medicare coverage is ending. The phone number for the Quality Improvement Organization (QIO) should be included in this notice. The second is a detailed notice (called a detailed Explanation of Provider Non-coverage) that the provider will deliver to the beneficiary and the appropriate QIO only if the beneficiary requests an expedited review by the QIO of the decision that coverage for the items and/or services should end.” Review of the agency’s discharge list provided by the Administrator on 8/22/23, included 1 Goals Met patient (Patient 1). Review of the discharge list included Patient 1 had a SOC date of 4/28/22 and a discharge date of 6/7/22. Listed in the discharge comments section included “pt DC from agency all goals met.” Review of Patient 1’s discharge record included a POC with a SOC date of 4/28/22 and a certification period of 4/28/22 – 6/26/22. The POC listed a primary diagnosis of antiphospholipid syndrome (a disorder in which the immune system mistakenly attacks normal proteins in the blood that can cause blood clots to form). Other diagnoses included ESRD, dependence on renal dialysis and transplanted organ and tissue status. The POC included orders for skilled nursing….. Review of Patient 1’s discharge OASIS signed and dated on 6/7/22 by RN F included the reason for discharge as “goals met.” Review of Patient 1’s entire record did not include the required NOMNMC. The surveyor conducted an interview with the Administrator on 8/30/23 at 3:00 PM and discussed the findings. The Administrator said she was unable to find the NOMNC notice. The Administrator said the patient was being seen by skilled nursing to teach the patient and family on the administration of an injection to the patient and said the patient and family were willing and able to administer the injection, so the patient was discharged. The Administrator stated she was not aware of the two-day notice requirement . Policy: “Patient/Client Transfer and Discharge Notices” with a revised date of 080120. “Policy…III. The agency will deliver the Notice of Medicare Non-Coverage (an OMB-approved Medicare form) to the patient/client, or representative, at least two (2) calendar days before Medicare covered services end, or the second to last day of service if care is not provided daily.”