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CoP Educational Series Part 5: Conclusion of CoP 484.50

Posted on Thursday, July 13, 2017 12:50 PM

The remainder of 484.50, which includes the new standards of Transfer and Discharge, Investigation of Complaints and Accessibility will be highlighted in this post. 

The first standard is Transfer and Discharge. The revised standard defines the circumstances for when a home health agency is allowed to transfer or discharge a patient. This includes the following:

1. When a transfer or discharge is necessary for the welfare of the patient
2. The payor and/or patient will no longer pay for the care or services
3. The patient’s physician and the agency agree the patient has achieved the desired outcomes or measurable goals as stated in the plan of care
4. The patient refuses services
5. When the home health agency determines, based on written policy the patient can be discharged for cause
6. Patient death
7. If the home health agency closes

Because transfers and discharges are now governed by this new standard, agencies must have policies and procedures in place to reflect this standard. A key consideration related to this standard is the patient’s right to refuse care – which is not a new right.  If a patient refuses services or care, this does not automatically mean the patient should be discharged. The agency needs to consider if the care and services the patient is refusing will compromise the home health agency from delivering safe and effective care to the extent the agency can no longer meet the patient’s needs.   The agency will need policy and procedures in place to assist in the management when refusal of services and care becomes a discharge and ensure documentation supports the decision-making process.

As defined by the standard – Investigating Complaints, home health agencies now must receive and investigate complaints from the patient, the patient representative and the patient’s caregivers and/or family. Included but not limited to are any complaints related to the treatment of care delivered or care that is failed to be delivered or delivered inconsistently or inappropriately.  In addition, any mistreatment, neglect, or verbal, mental, physical, or sexual abuse including injuries of an unknown source and/or misappropriation of the patient’s property by anyone furnishing services on behalf of the home health agency.

The complaint must be documented by the home health agency and must include the steps taken to investigate and resolve the complaint. The agency must also take actions to prevent further violations or retaliations against the complainant while the investigation is underway. This could include actions such as reassigning staff and or suspending staff.

If an employee suspects maltreatment, neglect or abuse of any kind, injuries from an unknown source, or misappropriation of the patient’s property it is the employee’s responsibility to report their suspicions immediately to their supervisor and/or the home health agency per their agency policies. The agency has a responsibility to report any suspicions on behalf of the employee to the appropriate state agencies as indicated.

Accessibility is the requirement for agencies to provide information in plain language and in a manner that is accessible and timely. This includes providing accessible websites and auxiliary aides in accordance with the Americans with Disabilities Act as well as the Rehabilitation Act.  If the patient and or patient representative has limited English proficiency, oral interpreters and written translations must be provided.  

Ensuring all employees are properly educated on the implications of each of the above standards is necessary. Those caring for patients have a responsibility to understand these requirements to ensure the safe and effective care that is compliant with all regulations for each patient. 

Written by Peggy Patton, Vice President of Education Services

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