Every finding on record at Florida Home Bound Mental Health Agency Inc

An Extended Complaint Survey for complaint #2021014084, was conducted on November 09, 2021 at Florida Home Bound Mental Health Agency Inc. The Home Health Agency was found to be in non-compliance with Conditions of Participation for 42 CFR 484 Subpart A-C requirements for Home Health Agencies.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency (HHA) failed to protect and promote the exercise of patient rights: the HHA failed to inform patients of their rights (G408); The HHA failed to provide written notice of the patients’ rights and responsibilities, and the HHA's transfer, and discharge policies as set forth in paragraph (d) of this section (G412); the HHA failed to obtain the patients’ or legal representatives’ signatures confirming that patients received a copy of the notice of rights and responsibilities. (G418); The HHA failed to ensure that patients participated in, were informed about, or authorized the HHA to change health insurance provider (G434); the HHA failed to advise patients orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. (G440); The HHA failed to advise patients of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. (G444) The cumulative effect of these systemic practices resulted in the agency's inability to protect and promote the exercise of these rights by the patients / representatives

Notice of rights CFR(s): 484.50(a) Standard: Notice of rights. The HHA must- This STANDARD is not met as evidenced by: Based on record review, policy review, and interview, the Home Health Agency failed to inform 3 out of 3 Sampled Patients (SP) of their rights. SP#1, SP#2, and SP#3 Review of SP#1, SP#2, and SP#3’s records conducted on 11/09/2021 revealed no documentation that the Home Health Agency provided information on patients’ rights to the clients. A review of the agency’s policy and procedure manual revealed the following “Bill of Rights and Responsibilities Procedure 1. The Patient Bill of Rights and Responsibilities should be reviewed with the patient and patient’s representative (If any) prior to the beginning of care, treatment or services or during the initial evaluation visit before beginning care, treatment or service.” During an interview conducted on 11/09/2021 at 2:35 PM, the Administrator acknowledged that SP#1, SP#2, and SP#3’s records did not contain documentation to show that the agency provided information on patients’ rights to the clients.

Written notice of patient's rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient's rights and responsibilities under this rule, and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency (HHA) failed to provide written notice of the patients’ rights and responsibilities under this rule, and the HHA's transfer, and discharge policies as set forth in paragraph (d) of this section to 3 out of 3 Sampled Patients (SP). SP#1, SP#2, and SP#3 Review of SP#1, SP#2, and SP#3’s records conducted on 11/09/2021 revealed no documentation that the Home Health Agency provided written notice of the patients’ rights and responsibilities, and the HHA's transfer, and discharge policies to the patients. A review of the agency’s policy and procedure manual revealed the following “Bill of Rights and Responsibilities Procedure 2. The admitting professional discipline must provide the patient and the patient’s representative (if any) the following during the initial evaluation visit (prior of providing care or treatment): Written notice of the patient’s Bill of Rights and Responsibilities and the Agency’s transfer and discharge policies within four (4) business days of the initial evaluation visits.” During an interview conducted on 11/09/2021 at 2:36 PM, the Administrator acknowledged that SP#1, SP#2, and SP#3’s records did not contain documentation to show that the agency provided written notice of the patient’s Bill of Rights and Responsibilities and the Agency’s transfer and discharge policies to the patients.

Patient's or legal representative's signature CFR(s): 484.50(a)(2) Obtain the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities. This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency failed to obtain the patients’ or legal representatives’ signatures confirming that 3 out of 3 Sampled Patients (SP) received a copy of the notice of rights and responsibilities. SP#1, SP#2, and SP#3 Review of SP#1, SP#2, and SP#3’s records conducted on 11/09/2021 revealed no documentation showing that the agency obtained the patients’ or legal representatives’ signatures confirming that they received a copy of the notice of rights and responsibilities. A review of the agency’s policy and procedure manual revealed the following “Bill of Rights and Responsibilities Procedure 3. The patient’s or patient’s representative (if any) shall sign the form, confirming that his or she has received a copy of the notice of Patient’s Bill of Rights and Responsibilities. 8. A copy of the form shall be left in the patient’s residence; the original shall be placed in the patient’s clinical record.” During an interview conducted on 11/09/2021 at 2:40 PM, the Administrator acknowledged that SP#1, SP#2, and SP#3’s records did not contain documentation to show that the agency obtained the patients’ or legal representatives’ signatures confirming that they received a copy of the notice of rights and responsibilities.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on interview, record review and policy review, the Home Health Agency (HHA) failed to ensure that 1 out of 3 Sampled Patients (SP) participated in, was informed about, or authorized the HHA to change the patient's health insurance provider on the patient's behalf. SP#1 During an interview conducted on 11/09/2021 at 10:35 AM, the Administrator stated “Medicaid has a new rule. I contacted the patients that have HMOs (Health maintenance organization). I contacted them a day before it became effective because I wanted to be sure that I was right. I called them to inform them of the rule and that they wouldn’t receive the services if they don’t follow the rule. There were two people that were really upset. There was one client that called and complained, I don’t remember who.” Review of the agency’s complaint log revealed SP#1 called the agency on 10/04/2021, and stated she doesn't need the services, and that she was going to another agency. On 11/09/2021 at 11:03 AM, the surveyor requested SP#1’s record. The Administrator stated that SP#1's insurance plan changed, and Staff A called her and spoke to her. The Administrator stated that the communication should be documented in her records. Review of SP#1’s record conducted on 11/09/2021 at 11:41 AM revealed that the patient was admitted on 08/28/2018. Further review of SP#1’s record revealed that the agency provided Home Health Aide (HHA) services to the patient. Continued review of SP#1’s record revealed two sections titled “Communication notes Episode 08/12/2021 to 10/06/2021” and “Episode summaries Episode 08/12/2021 to 10/06/2021” that showed “No records to display”. Additional review of SP#1’s record revealed no documentation that Staff A spoke nor contacted the patient during the episode of 08/12/2021 to 10/06/2021 as previously stated by the Administrator. A review of the Home Health Agency’s policy and procedure manual conducted on 11/09/2021 revealed “Coordination of Services Procedure 4. Case conferences/Communication Notes are documented in the patient’s clinical record.” During a telephone interview conducted on 11/09/2021 at 1:42 PM, SP#1 stated the Administrator never told her that her insurance plan was changing at all. She stated the Administrator only said because you have Medicaid and Medicare now, you will have different services where they’re going to come to your house. Sampled patient #1 stated the Administrator said that physical therapy and the podiatrist would make home visits. Sampled patient #1 said she never discussed anything about her health care, or her plan changing. Sampled patient #1 stated she didn’t know that her plan was changed until she went to the store and tried to purchase some items. Sampled patient #1 stated the Administrator just said in October, you’re going to have physical therapy and more services as a Medicaid and Medicare beneficiary, and that was all the Administrator told her. Sampled patient #1 contacted social security and Department of Children and Families and they said that SP#1 changed her plan when she never did. Sampled patient #1 stated It’s been a hassle because she hadn’t received the new insurance cards, so she couldn’t get dental care and she’s been in pain. During an interview conducted on 11/09/2021 at 2:12 PM, the Administrator stated she told SP#1 if she stayed with her health plan, that she would lose her services. The Administrator stated that she told SP#1 that her physician would make home visits to her home to see her. The Administrator explained that she asked SP#1 if she would like the home health agency to make the change in her health plan for her, and SP#1 stated yes, and that the change was made while SP#1 was on the phone. On 11/09/2021 at 2:14 PM, the Administrator acknowledged that SP#1’s record did not contain documentation to demonstrate that the Administrator contacted SP#1 on 09/29/2021 nor obtained the SP#1’s authorization to change her health insurance provider.

Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency failed to advise, orally and in writing, of: (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. SP#1, SP#2, and SP#3 Review of SP#1, SP#2 and SP#3's records conducted on 11/09/2021 revealed no documentation showing that the agency established a written agreement with the patients at the start of services on 08/28/2018, 11/05/2015 and 08/05/2021 respectively. A review of the agency’s policy and procedure manual revealed the following “Bill of Rights and Responsibilities Procedure 6. The Patient’s Bill of Rights and Responsibilities form, the patient has the right to: g. Be advised of i. The extend to which payment for agency services may be expected from Medicare, Medicaid or any other federally-funded or federal aide program known to the Agency.” During an interview conducted on 11/09/2021 at 2:42 PM, the Administrator acknowledged that SP#1, SP#2, and SP#3's records did not contain documentation showing that the agency established a written agreement with the patients on 08/28/2018, 11/05/2015 and 08/05/2021 respectively.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on record review, policy review, and interview, the Home Health Agency (HHA) failed to advise 3 out of 3 Sampled Patients (SP) of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. SP#1, SP#2, and SP#3 Review of SP#1, SP#2, and SP#3's records conducted on 11/09/2021 revealed no documentation that the agency provided the Abusive, neglectful, or exploitative practices/ Complaints/Medicaid fraud notices to the patients. A review of the agency’s policy and procedure manual revealed the following “Bill of Rights and Responsibilities Procedure 6. The Patient’s Bill of Rights and Responsibilities form, the patient has the right to: h. Be advised of the state toll free home health telephone hotline, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about the local Home Health Agencies.” During an interview conducted on 11/09/2021 at 2:46 PM, the Administrator acknowledged that SP#1, SP#2, and SP#3's records did not contain documentation to show that the agency provided the notices to the patients.