Every finding on record at Integracare Home Health Services Inc

A recertification survey was initiated on 10/31/2022. The census was: LHH-0 LCHH: Grapevine/Parent-70 Olney/Branch-33 Graham/Branch-39 Greenville/Branch-113 Mineral Wells/Branch-87 Bridgeport/Branch-55 Total agency census: 397 The agency was in substantial compliance with 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies.

A recertification survey was initiated on 10/31/2022. The census was: LHH-0 LCHH: Grapevine/Parent-70 Olney/Branch-33 Graham/Branch-39 Greenville/Branch-113 Mineral Wells/Branch-87 Bridgeport/Branch-55 Total agency census: 397 Abbreviations LHH-Licensed Home Health LCHH-Licensed and Certified Home Health NOMNC-Notice of Medicare Non-Coverage EMR-electronic medical record

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 provide the NOMNC written notice at least two days in advance of terminating on-going care in 3 (Patient 13, 16, and 17) of 5 discharged records reviewed whose reason for discharge was “goals met". The failure of the agency to protect the rights of the patient by informing in advance of their right to appeal the discontinuation of home health services prevented the identified patient from exercising their right to appeal the discharge decision, if they chose to appeal. Findings include: DISCHARGED PATIENT 13: Record review of the EMR contained a POC dated 07/22/2022-09/19/2022 with a SOC date of 07/22/2022. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 09/15/2022 ..." The form was signed and dated by Patient 13 on the discharge date of 09/15/2022. The record failed to contain any documentation that Patient 13 had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. DISCHARGED PATIENT 16: Record review of the EMR contained a POC dated 06/11/2022-08/9/2022 with a SOC date of 06/11/2022. The record failed to contain any documentation that Patient 16 had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. DISCHARGED PATIENT 17: Record review of the EMR contained a POC dated 08/20/2022-10/18/2022 with a SOC date of 08/20/2022. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 09/1/2022 ..." The form was signed and dated by Patient 17 on the discharge date of 09/1/2022. The record failed to contain any documentation that patient had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. During an interview with the Supervising Nurse, on 11/4/2022 at approximately 3:05 p.m., the Supervising Nurse was asked why the NOMNC for Patients’ 13, 16 & 17 were not provided at least 2 days prior to discharge. The Supervising Nurse said, “I am not sure why.” The Supervising Nurse was asked how not providing the NOMNC at least 2 days prior to discharge could impact the patients. The Supervising Nurse said that the patients could be dissatisfied because they would not have the opportunity to appeal the discharge. Agency policy titled "Discharge or Transfer: read in part ...”Whenever the agency is making the determination to discharge, Medicare and Medicare Replacement Plan patients are to be provided advance notice of discharge utilizing the Centers for Medicare & Medicaid Services (CMS) Notice of Medicare Non-Coverage (NOMNC) form. Patient Notification will be no less than two days in advance…”