Every finding on record at Recover Health of Iowa, Inc.

A complaint health survey for compliance with 42 CFR Part 484, Subpart G, Subsections 484, Subparts B-C, requirements for Home Health Agencies, was conducted from 1/7/26 through 1/8/26. Areas surveyed included therapy services initiated, timely and skilled nurse assessments. Aveanna Home Health was found not in compliance with the following requirement, G510.

Comprehensive Assessment of Patients CFR(s): 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. This CONDITION is not met as evidenced by: Based on record review, interview, and policy review, the provider failed to ensure that complete vital signs were documented in the electronic medical record (EMR) in the Skilled Nurse Initial Comprehensive Assessment, the second skilled nurse visit note, and the physical therapy evaluation for one of three patient (1) records reviewed. Findings include: 1. Record Review of patient #1’s EMR on 1/8/26 revealed: *The patient was admitted to home health services on 12/23/25 after being discharged home from a rehabilitation stay for hemiplegia following cerebral infarction (inability to move affected muscles voluntarily after a stroke where blood flow to part of the brain is blocked). *There were no vital signs recorded in the skilled nurse's initial comprehensive assessment completed on 12/23/25, the patient's home health start of care date. *There were no vital signs documented in the skilled nurse visit note dated 12/30/25, the second home health visit made with the patient. *The patient's respirations were the only vital sign documented in the initial physical therapy evaluation completed on 12/30/25, the third home health visit with the patient. *The patient was prescribed and took Lisinopril and Metoprolol medications for high blood pressure. *The initial plan of care, developed on 12/23/25 at the start of care and signed by the patient's physician on 1/5/26, listed the intervention that licensed professionals were to report vital signs falling outside established parameters. 2. Interview with Area Executive Director B on 1/8/26 at 9:00 a.m. regarding missing vital signs documentation in the EMR revealed that he: *Confirmed there were no vital signs documented in the EMR for the skilled nurse's initial comprehensive assessment completed on 12/23/25 at patient 1’s home health start of care visit, the second skilled nurse visit on 12/30/25, and respirations were the only vital sign documented in the physical therapy initial evaluation completed on 1//25 for patient 1. *Agreed that an assessment is not comprehensive without the patient's vital signs being completed. *Stated that the agency's process was for vital signs to be completed by the home health nurse and therapy staff for patients at every skilled nursing and physical therapy visit. 3. Interview on 1/8/26 at 10:00 a.m. with registered nurse E revealed he: *Agreed vital signs are required and part of a patient's comprehensive assessment. *Stated vital signs were to be completed for patients at every skilled nurse visit. *Confirmed there was no documentation of vital signs in the EMR for the skilled nurse's initial comprehensive assessment completed on 12/23/25 at patient 1’s home health start of care visit, the second skilled nurse visit on 12/30/25, for which he was the nurse, and respirations were the only vital sign documented in the physical therapy initial evaluation completed on 1//25 for patient 1. 4. Interview on 1/8/26 at 10:45 a.m. with patient 1 and the patient's spouse revealed: *The nurse who completed the patient's first and second home health visits on 12/23/25 and 12/30/25 did not take the patient’s vital signs. *The physical therapist who completed the patient's third home health visit on 12/30/25 reviewed the blood pressure that was taken with the patient's own wrist blood pressure cuff and stated it was normal. *The patient had a wrist blood pressure cuff; She and her husband would take her blood pressure daily, document it in a notebook, were aware of normal blood pressure parameters, and stated that they would call the doctor if the blood pressure were high. 5. Interview on 1/8/26 at 2:00 p.m. with physical therapist F revealed: *It is the agency's therapy services process that vital signs are to be completed for all patients at every physical therapy visit and documented in the patient's EMR. 6. Review of the provider's “Admission and Acceptance to Service” policy dated 3/11/25 revealed: *”Once a patient is admitted to service, the organization is responsible for providing care and services within its financial and service capabilities, mission, and applicable law and regulations.” *”If the patient is accepted for care, an initial plan of care will be developed in consultation with the physician and the patient, then submitted to the physician for signature.” *The comprehensive assessment must be completed within (5) calendar days of the patient’s start of care, inclusive of weekends, holidays, and weekday admissions.” 7. Review of the provider’s ”Therapy Services” policy dated 5/19/25 revealed: *”4. Therapy evaluations will be completed, timely in accordance with federal/state regulations, accreditation standards and/or payor requirements.” *”Therapy evaluations may include but is not limited to:” -“c. Relevant systems review -d. Functional tests, standardized testing, and objective measurements.”

A partial extended recertification survey for compliance with 42 CFR Part 483, Subpart G, Subsection 484.102, Emergency Preparedness Requirements for Home Health Agencies, was conducted from 1/10/22 to 1/12/22. Aveanna Home Health was found not in compliance with the following requirements: E001 and E0017.

Establishment of the Emergency Program (EP) CFR(s): 484.102 §403.748, §416.54, §418.113, §441.184, §460.84, §482.15, §483.73, §483.475, §484.102, §485.68, §485.625, §485.727, §485.920, §486.360, §491.12 The [facility, except for Transplant Programs] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility, except for Transplant Programs] must establish and maintain a [comprehensive] emergency preparedness program that meets the requirements of this section.* The emergency preparedness program must include, but not be limited to, the following elements: * (Unless otherwise indicated, the general use of the terms "facility" or "facilities" in this Appendix refers to all provider and suppliers addressed in this appendix. This is a generic moniker used in lieu of the specific provider or supplier noted in the regulations. For varying requirements, the specific regulation for that provider/supplier will be noted as well.) *[For hospitals at §482.15:] The hospital must comply with all applicable Federal, State, and local emergency preparedness requirements. The hospital must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. The emergency preparedness program must include, but not be limited to, the following elements: *[For CAHs at §485.625:] The CAH must comply with all applicable Federal, State, and local emergency preparedness requirements. The CAH must develop and maintain a comprehensive emergency preparedness program, utilizing an all-hazards approach. The emergency preparedness program must include, but not be limited to, the following elements: This CONDITION is not met as evidenced by: Based on policy review and interview, the provider failed to establish a comprehensive emergency preparedness (EP) program. Findings include: 1. Interview and review on 1/12/22 at 4:30 p.m. with administrator A and clinical services coordinator B of the provider's EP Plan revealed: *There was no effective date on the plan to indicate when the plan had been implemented and last reviewed. *The provider had not: -Been able to locate the EP binder until the third day of the survey. -Included a comprehensive list of the patients that were currently receiving home health services. -Included individualized emergency plans for each patient in the EP binder. -Included an employee call tree in the binder. -Made contact with the tribal, county, state, or federal emergency offices for collaboration. Not all counties listed as territories where the provider did business were listed on the EP Plan. *Administrator A stated the EP plan: -Had included some hospitals, a nursing home, a home health agency, and an assisted living with phone numbers, but those providers had not been contacted to collaborate on an emergency plan. --Had not contained contracts for collaboration of emergency assistance. *Further review of the EP plan with Administrator A revealed: -Two EP tabletop trainings had occurred: One training for winter preparedness in April 2021 and one for tornadoes in July 2021. There was no documentation of those trainings. -The provider had not participated in a full-scale community-based exercise program.

HHA Comprehensive Assessment in Disaster CFR(s): 484.102(b)(1) §484.102(b)(1) Condition for Participation: [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (1) The plans for the HHA's patients during a natural or man-made disaster. Individual plans for each patient must be included as part of the comprehensive patient assessment, which must be conducted according to the provisions at §484.55. This STANDARD is not met as evidenced by: Based on observation, record review, and interview, the provider failed to maintain patient specific emergency information in an easily assessible manner for one of one sampled patient (3) and for all current patients. Findings include: 1. Observation on 1/11/21 at 9:50 a.m. revealed patient 3 lived in a second-floor apartment. There was an elevator present at the end of the hallway that could be used between the first and second floors. He utilized a wheelchair for movement within his apartment as he was not able to ambulate. Observation while the patient received occupational therapy (OT), revealed he was unable to stand without the use of a walker and the OT's assistance. Interview on 1/11/22 at 3:30 p.m. with administrator A and review of patient 3's electronic medical record revealed: *He had been assigned an evaluation plan according to his current needs. *A copy of the emergency evacuation plan had been provided to patient 3 by the registered nurse upon admission. *That plan had not been uploaded into the current Home Care Home Base (HCHB) computer software that was implemented on 11/8/21. Further interview with administrator A revealed: *The only way they would know in the event of an emergency was to contact each case manager to determine what every patient's evacuation plan was. *They would have to rely on the case manager's memory in the event of an emergency. *There was no plan in place that would have provided immediate information to all of the staff. *Prior to the HCHB software program they had a spreadsheet detailing each patient's emergency requirements. -Those requirements were rated one to three with three requiring more assistance in the event of an emergency. Refer to E0001.

A partial extended recertification survey for compliance with 42 CFR Part 484, Subparts B-C, requirements for home health services, was conducted from 1/10/22 to 1/12/22. Aveanna Home Health was found not in compliance with the following requirements: G444, G710, G714, G800, and G848.

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 admission packet reviews and interviews, the provider failed to ensure patients were provided with the South Dakota Department of Health (SD DOH) toll-free hotline phone number to file a complaint. Findings include: 1. Review of the provider's RecoverHealth patient admission packet revealed no documentation for the SD DOH toll-free hotline phone number. There was information listed to contact the local administrator to file a grievance immediately or to notify the regional director through the corporate office. The office location was listed with a local phone number and the out-of-state corporate office provided a long-distance phone number. Review of the page titled Health Care Directives there was State Health Care Hotline toll-free number. When that number was called the recorded message indicated it was for the Wisconsin complaint department, not SD DOH. Review of the provider's folder for "aveanna homehealth" was a "Patient Booklet". Within the section for grievances, the patient or caregiver was directed to contact through a 1-800 number the assistant vice president of compliance located in Georgia. Further instructions to file a complaint were through the United States Department of Health and Human Services or electronically through the Office for Civil Rights Complaint Portal. This could be done through mail, an online link, or a 1-800 number. Review of above patient admission folders and interview on 1/10/22 at 1:35 p.m. with administrator A revealed: *They provided the patients upon admission the RecoverHealth folder. *The "aveanna home health" folder was not in current use. *There was a recent name change of the home health agency from Recover Health to Aveanna Home Health. Interview on 1/10/22 at 1:40 p.m. with clinical care coordinator B revealed she had orientated with the registered nurses (RN) in September or October 2021. The toll-free number for SD DOH complaints had not been part of the patient admission education. Interview 1/10/22 at 4:35 p.m. with RN C revealed: *The call-in information was located in the patient's admission packet. *She obtained the new "aveanna home health" admission packet and confirmed there was no SD DOH toll-free number for the patients to call should they have had a complaint. *The patients were to contact the regional director through the corporate office. Interview on 1/11/22 at 8:43 a.m. with administrator A the new admission packet had been provided to the nurses however, they were to use the old admission packets. The provider name change had occurred at the beginning of the year and they were still working on the new processes for the agency. Interview on 1/11/22 at 9:50 a.m. with patient 3 who was admitted on 12/21/21 to receive home health services revealed he did not know where to file a complaint if he had one or if there was a toll-free number for SD DOH. Review of the provider's 2/1/20 C-19 Client Grievance policy and procedure revealed: "Grievances can also be filed with the State Department of Health. -Information was provided on admission." --There was no toll-free number listed. Review of the provider's 12/4/17 Notice of Rights and Responsibilities/Home Care Bill of Rights policy and procedure revealed the client has the right to "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 local HHAs."

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review, interview, and policy review, the provider failed to follow physician's orders for one of two sampled patients (7) home health aide (HHA) visits. Findings include: 1. Review of patient 7’s Home Health Certification and Plan of Care (POC) for the first certification period of 8/4/21 through 10/2/21 revealed: *His start of care was on 8/4/21. *An 8/4/21 physician’s order for HHA visits to have been completed: -One time weekly for the week of 8/4/21 through 8/7/21. -Twice weekly for eight weeks 8/8/21 through 10/2/21. *An entry on the POC had indicated the HHA visits had been discontinued on 8/20/21. Further review of patient 7’s electronic medical record revealed a visit schedule for HHA visits indicating: *Patient 7 had received a HHA visit on 8/6/21. *On 8/10/21 there was a missed HHA visit because he had gone for an appointment. *On 8/13/21 the patient had refused a HHA visit. *The schedule had not identified HHA visits for the week of 8/15/21 through 8/21/21. *There were no further HHA visits on the August, September, or October 2021 schedule. Interview on 1/12/22 at 3:30 p.m. with administrator A and clinical services coordinator B regarding patient 7’s missed visits on 8/10/21, 8/13/21, and the two missed visits for the week of 8/15/21 through 8/21/21 revealed: *They were not: -Sure why the patient's HHA visits had been discontinued. -Able to locate documentation the physician had been notified of the missed visits. -Able to locate a physician’s order to discontinue the HHA visits. *Administrator A confirmed his expectation was: -The physician should have been notified of the missed visits. -The provider should have requested a physician’s order prior to discontinuing the HHA visits. Review of the provider’s January 2018 Missed Visits policy revealed: *Each client (patient) should have received the services written in their plan of care. *All missed visits should have been relayed to the physician who established the care plan. *If the agency was consistently unable to provide services ordered, it should have been documented the agency had made attempts to fill the hours and the physician should have been notified. Review of the provider’s November 2014 Physician’s Orders policy regarding a change in the POC revealed: *The physician should have been consulted to approve any additions or modifications to the original POC and should have been notified of any changes in the patient’s condition which indicated changes in the POC. *“Supplemental orders are documented in the patient’s record, implemented, and must be signed and dated by a physician.” *“A missed visit alters the plan of care and the physician must be notified and documentation in the clinical record must indicate that the physician is aware of the missed visit.”

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on record review and interview, the provider failed to educate and document one of one sampled patient's (5) education related to the importance of monitoring her weight with a diagnoses of heart failure. Findings include: 1. Review of patient 5's electronic medical record revealed a 9/10/21 hospital report for an acute exacerbation of congestive heart failure (CHF), chronic kidney disease, and combined systolic and diastolic heart failure. Intravenous Lasix and chlorothiaizide had been administered with a decrease in leg and foot swelling from the edema. Review of patient 5's 11/30/21 to 1/28/22 home health certification and plan of care revealed a diagnosis for acute heart failure. The skilled nurse was to during their twice-weekly visits: *Evaluate and develop a plan of care to assess and evaluate co-morbid conditions including hypertension and heart failure. *To identify changes and intervene to minimize complications requiring skilled nursing for disease education. *Observe and assess the cardiovascular system to identify changes and intervene to minimize complications. The skilled nurse would provide skilled teaching related to altered cardiovascular status. *"Provide instructions related to management of congestive heart failure including but not limited to definition, risks factors, measures to prevent exacerbation, signs/symptoms and potential complications." *Observe and assess respiratory system to identify changes and intervene to minimize complications. To provide teaching related to altered respiratory status. *The above orders for discipline and treatment did not include education or monitoring of the patient's weight. *Review of the physical therapist and occupational therapist discipline and treatment plan did not include monitoring the patient's weight. Review of the above home health certification and plan of care "Goals/Rehabilitation Potential/Discharge Plans" for patient 5 revealed the patient/caregiver would verbalize: *Management of the cardiovascular disease as evidenced by no unplanned hospitalizations by discharge, *Understanding and demonstrating compliance with management of CHF as evidenced by a stabilized weight and no unplanned hospitalizations. *The above goals and discharge plans did not address the monitoring of her weight. Review of patient 5's following visit note reports revealed: *On 12/5/21 the physical therapist documented the patient's weight was not obtained. "Pt [patient] doesnt normally take weight." *On 12/6/21 the registered nurse (RN) under the vital sign section documented the patient weighed one-hundred twenty-three pounds. There was a goal to decrease leg swelling. Under interventions: -To provide instructions on pathophysiology related to cardiovascular disease it listed the patient had been "Instructed on importance of weight monitoring with a weight log and the use of the same scale when obtaining weights including the need to report weight changes of 3 or more lbs. [pounds.]" -To provide instructions on CHF to include it listed the patient had been "Instructed to immediately report.....a weight gain of 2-4 pounds." *On 12/7/21 the physical therapy assistant (PTA) documented the patient's weight not obtained as there was no scale available. *On 12/12/21 "VISIT DATE: 12/10; ATTEMPT TO RESCEHDULE DETAILS; CLIENTS STATED THAT ROADS WERE NOT PLOUD MORNING OF 12/11 AMD [AND] ASKED THAT SKILLED NURSE JUST FOLLOW UP NEXT WEEK". *On 12/15/21 the PTA documented the patient's weight was not obtained because the scale was not working. *On 12/16/21 the RN documented "Attempt to reschedule details: Client is in the hospital. She is on observation status for fluid retention." Review of patient 5's 12/20/21 hospital discharge summary revealed she had been admitted for diuresis. She required intravenous Lasix 200 milligrams twice daily and chlorothiazide 500 milligrams daily. The discharge plan included daily weights. Interview on 1/12/22 at 11:23 a.m. with clinical care coordinator B regarding patient 5 revealed: *She had visited with the RN and found out she had obtained the patient's weight using the scale that she had in her personal vehicle. *They had scales in their supply room the RN should have obtained and taken to the patient's residence to monitor weights with each home health visit. *She was not aware the patient's weights had not been consistently obtained. *Obtaining weights on a patient with CHF and combined systolic and diastolic heart failure is considered a standard of care and the weights should have been obtained and documented. *There was no documentation the RN had educated the patient on the importance of monitoring her weights on a daily basis. *The skilled nurse visits should have occurred twice weekly. The RN should have scheduled a visit immediately at the beginning of the following week after the 12/10/21 missed home visit and not wait until later in the week. *The patient was known to have frequent hospitalizations and the purpose of home health was to minimize rehospitalizations. *The skilled nurse was unaware of the patient's status until one and one-half weeks after the 12/6/21 home visit. -It was then identified the patient was in the hospital on 12/17/21. *There was no documentation by the RN regarding the status of the resident upon hospital admission or discharge plans. Interview on 1/12/22 at 4:15 p.m. with the regional director D revealed there was no policy, procedure, or a provider standard of care for monitoring weights.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on observation, record review, and interview, the provider failed to ensure one of two sampled patients (3) who required home health aide (HHA) services: *Promoted patient well-being, safety, and infection control measures. *Implemented an individualized care plan to ensure the specific needs of the patient had been identified and addressed on what was required during each home visit. Findings include: 1. Review of patient 3's 12/21/21 through 2/18/22 home health certification and plan of care revealed: *He was to receive HHA services twice a week. *His diagnoses included acute osteomyelitis of his right ankle and foot which required orthopedic aftercare, diabetes with circulatory complications, and kidney disease with dialysis. Review of patient 3's HHA care plan for the above recertification period revealed he would receive services for a wheelchair, bathing - shower, shower chair/bench, hair care, and dressing. There was no individualized information as to what was to have been completed by the HHA or what was meant by the wheelchair. There was no information related to patient safety, infection control, or household services essential to health care at home. Observation and patient 3's comments during the 1/11/22 home visit with occupational therapist (OT) who provided OT therapy revealed: *He was seated in a wheelchair with a right foot boot cast and no shoe on his left foot with an exposed prior amputation of his first toe. The amputation was currently healed. *Commented he was to receive three hours a week to assist with cleaning up his apartment. [Registered nurse's name E] is to come today. "I try - can't do it." Further indicated his son who lived in a nearby town was not a willing participant to assist him. *On the floor from the entrance to the living room wall outside window: -A large quantity of opened and unopened mail on the floor included an unsigned check, social security information, and bills in the main living area. -Many empty pop, water, and juice bottles. -Tissue paper, empty grocery bags, and grocery bags with food items. -Clean laundry in a laundry basket and dirty laundry on the floor in various areas of the room. -A stand-up fan with a folded walker was located leaning against the wall behind the fan. There was a grab-reacher partially under the walker. --Patient 3 asked the OT to pick it up for him as he was not able to reach it. The OT handed him the grab-reacher. While seated in the wheelchair he commented he was looking for certain paperwork he needed that day. After several attempts using the grab-reacher, he was finally able to pick up the social security letter from the floor. He indicated that was not the letter he wanted. -Brown carpet stains in several areas of the living room. *Commented he had diarrhea over the weekend. EMS had been at his home. "My bathroom is a mess. I had to take a shower alone last night as I was so filthy dirty after the weekend. My bathroom is a mess." *The OT had not inquired regarding the EMS services being at his home. She: -Commented he should not independently take a shower without assistance. -Did not observe the condition or the status of the bathroom for cleanliness. *In the kitchen two cupboard doors were open and the microwave door was open. Mail, food spills, a tong, wooden spoon, an empty pizza box, and a washcloth were on the floor. *In the bedroom visible from the living room area there was linen rolled up in a ball on the unmade bed and linen on the floor at the foot of the bed. During the home visit, the doorbell rang. Patient 3 indicated when that sound occurred there was someone at the front. Patient 3 with both hands slowly propelled the wheelchair over the carpet to the apartment entrance. There he was able to use the wall-mounted control to open the front door. This allowed access to the apartment building. That individual knocked on patient 3's apartment door entrance and patient 3 verbalized the individual could enter his apartment to bring in a package and more mail. Patient 3 indicated the individual could place the mail on top of the clean laundry in the laundry basket on the floor. There was no form of any table in his apartment. Review of patient 3's electronic medical review revealed beginning 12/28/21 five HHA visits had occurred. The HHA visits had been conducted by either the OT or registered nurse (RN) E. Interview on 1/12/22 at 11:00 a.m. with the administrator revealed: *It was unclear what was meant for wheelchair services on patient 3's HHA care plan. *The HHA visits had been billed as HHA visits and not as an OT or as an RN visit. *They paid the OT and RN their regular wages and not HHA wages for those visits. *They wanted the OT and RN to conduct the personal care an HHA would do during a home visit. *They did not want to pay OT or RN wages to conduct light duty housekeeping tasks during an HHA home visit. *A full-time HHA had started that week and was receiving training. They have not had a full-time HHA since sometime in 2020. They had used an as-needed HHA and office staff with prior aide status to fill in at times as an HHA. Review of the provider's undated HHA's position description revealed the HHA assisted clients with activities of daily living according to the client's plan of care. The major responsibilities/job functions included performing household services essential to health care at home and to provide supervision and observation for client safety. The reporting requirements included reporting any accidents/incidents involving an employee or client within twenty-four hours of an "[occurrence] (including occupational exposure)." The RN case manager, clinical manager, or administrator should be notified immediately regarding problems related to client services.

Compliance with Federal, State, Local Law CFR(s): 484.100 Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients. The HHA and its staff must operate and furnish services in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients. If state or local law provides licensing of HHAs, the HHA must be licensed. This CONDITION is not met as evidenced by: Based on record review, map review, and interview, the provider had administered home health care to patients in two of two service areas that had not been requested or approved by the Fiscal Intermediary (FI). Findings include: Review of the provider's home health service map and interview with administrator A on 1/11/22 at 9:2:30 p.m. revealed: *The map demonstrated fifteen highlighted counties the provider had been approved by the FI to provide home health services. *Counties not approved were Charles Mix and Bon Homme. *Patients 5 and 8 had received home health services in their homes located in those counties. *Their nurse lived in the area and had provided services. Interview on 1/12/22 at 11:12 a.m. with regional director D and administrator A confirmed Charles Mix and Bon Homme were not included in their service area. Those two counties would be requested by completion of the required paperwork and submission to the FI. Administrator A was not aware of how the system failure occurred when they accepted admissions for patient 5 and 8. Interview on 1/12/22 at 5:02 p.m. with regional director D revealed there was no specific policy related to approved service areas.