Current through Register Vol. 24-18, September 15, 2024
(1) For any home
health services to be payable, the medicaid agency requires home health
providers to develop and implement an individualized plan of care (POC) for the
client that must:
(a) Be documented in
writing and be located in the client's home health medical record;
(b) Be developed, supervised, and signed by a
licensed registered nurse or licensed therapist;
(c) Reflect the authorized practitioner's
orders and client's current health status;
(d) Contain specific goals and treatment
plans;
(e) Be reviewed and revised
by an authorized practitioner at least every 60 calendar days;
(f) Be signed by the authorized practitioner
within 45 days if a verbal order is given; and
(g) Be available to medicaid agency staff or
its designated contractor(s) on request.
(2) The provider must include all the
following in the POC:
(a) The client's name,
date of birth, and address to include name of residential care facility, if
applicable;
(b) The primary
diagnosis (the diagnosis that is most related to the reason the client
qualifies for home health services) or the diagnosis that is the reason for the
visit frequency;
(c) All secondary
medical diagnoses, including date or dates of onset or exacerbation;
(d) The prognosis;
(e) The type or types of equipment
required;
(f) A description of each
planned service and goals related to the services provided;
(g) Specific procedures and
modalities;
(h) A description of
the client's mental status;
(i) A
description of the client's rehabilitation potential;
(j) A list of permitted activities;
(k) A list of safety measures taken on behalf
of the client; and
(l) A list of
medications which indicates:
(i) Any new
prescription; and
(ii) Which
medications are changed for dosage or route of
administration.
(3) The provider must include in or attach to
the POC:
(a) A description of the client's
functional limits and the effects;
(b) Documentation that justifies why the
medical services should be provided in any setting where the client's life
activities take place instead of an authorized practitioner's office, clinic,
or other outpatient setting;
(c)
Significant clinical findings;
(d)
Dates of recent hospitalization;
(e) Notification to the department of social
and health services (DSHS) case manager of admittance;
(f) A discharge plan, including notification
to the DSHS case manager of the planned discharge date and client disposition
at time of discharge; and
(g) Order
for the delivery of home health services through telemedicine, as
appropriate.
(4) The
individual client medical record must comply with community standards of
practice, and must include documentation of:
(a) Visit notes for every billed
visit;
(b) Supervisory visits for
home health aide services as described in WAC
182-551-2120;
(c) All medications administered and
treatments provided;
(d) All
authorized practitioner's orders, new orders, and change orders, with notation
that the order was received before treatment;
(e) Signed authorized practitioner's new
orders and change orders;
(f) Home
health aide services as indicated by a registered nurse or licensed therapist
in a home health aide care plan;
(g) Interdisciplinary and multidisciplinary
team communications;
(h)
Inter-agency and intra-agency referrals;
(i) Medical tests and results;
(j) Pertinent medical history; and
(k) Notations and charting with signature and
title of writer.
(5) The
provider must document at least the following in the client's medical record:
(a) Skilled interventions per the
POC;
(b) Client response to the
POC;
(c) Any clinical change in
client status;
(d) Follow-up
interventions specific to a change in status with significant clinical
findings;
(e) Any communications
with the attending authorized practitioner; and
(f) Telemedicine findings, as
appropriate.
(6) The
provider must include the following documentation in the client's visit notes
when appropriate:
(a) Any teaching,
assessment, management, evaluation, client compliance, and client response;
and
(b) The client's physical
system assessment as identified in the POC.
(7) For any in-home delivered home health
services to be payable, the medicaid agency requires home health providers to
meet the electronic visit verification requirements.
11-14-075, recodified as §182-551-2210, filed
6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090, chapter 74.09 RCW, and 2009 c 326.
10-10-087, § 388-551-2210, filed 5/3/10, effective 6/3/10. Statutory
Authority:
RCW
74.08.090,
74.09.520,
74.09.530, and
74.09.500. 02-15-082, §
388-551-2210, filed 7/15/02, effective 8/15/02. Statutory Authority:
RCW
74.08.090 and
74.09.530. 99-16-069, §
388-551-2210, filed 8/2/99, effective
9/2/99.
