Understanding Home Health Services Regulations in Orange County

Are you looking for information on the special regulations and laws governing the provision of home health services in Orange County? If so, you've come to the right place. In this article, we'll discuss the regulations and laws that apply to home health services in Orange County, as well as the organizations that oversee them. All Medicare-certified Home Health Agencies (HHAs) that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee must compete in a model established by the Orange County Health Care Agency. Nine voting members are nominated by the Agency and appointed by a majority vote of the Orange County Board of Supervisors.

HHAs receive a 30-day, standardized national payment of a predetermined rate for home health services. This payment is subject to review by the Centers for Medicare & Medicaid Services (CMS) if an interim event occurs. An interim event is defined as a beneficiary chosen to transfer or discharge with goals met or with no expectation of returning to home health care, and the beneficiary has returned to home health care during the 30-day period. In addition to HHAs, personnel who provide HHA support services exclusively outside of settings where home health services are provided directly to patients and who have no direct contact with patients, family members, caregivers, and other personnel specified in paragraph (d) of this section are also subject to regulations.

Under § 476.78 of this chapter, an additional payment is made to a home health agency to cover the costs of sending requested patient records to the Quality Improvement Organization (QIO) in electronic format, by fax, or by photocopying and mailing. HHAs also receive a standardized, national prospective payment amount for home health services that were previously paid at a reasonable cost (except for the osteoporosis medication defined in section 1861 (kk) of the Act) as of August 5, 1997. For the purposes of home care Prospective Payment System (PPS), a sequence of adjacent episodes for a beneficiary is a series of claims in which there are no more than 60 days without home care between the end of an episode (day 60 except for episodes that have been adjusted according to the Prospective Episode Payment (PEP)) and the start of the next episode. If an unplanned transfer occurs during this time period, HHA must submit a full summary within two business days after learning about it. If HHA submits samples for laboratory testing, the reference laboratory must be certified in the specialties and subspecialties of the corresponding services in accordance with applicable requirements of part 493 of this chapter.

Personnel providing HHA support services must have at least one year of experience in social work in a health care setting and must possess a degree in social work, psychology, sociology or another field related to social work. The County Organized Health System (COHS) is a system of services provided by or through a county under these provisions. The Division of Health Services Regulation works together with local county departments of social services (DSS) to monitor centers in their respective counties at least quarterly, investigate complaints and accompany state inspection teams in annual surveys. The information contained in medical records must be accurate and meet current practice standards for documenting medical records. It must also be available to doctors or authorized professionals who issue orders, to the home health plan and to appropriate HHA personnel. CalOptima Health was created in 1993 in response to a health system that was striving to meet the needs of vulnerable Orange County residents.

The program must be capable of showing measurable improvement in indicators that will improve health outcomes, patient safety and quality of care.

Alison Podolak
Alison Podolak

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