Lehigh Valley Home Care

Lehigh Valley Home Care is a non-profit home care agency and is part of the Lehigh Valley Health Network. The agency services an area over 2,500 square miles in size with over 1,480,000 residents. Lehigh Valley Home Care offers nursing care, physical therapy, occupational therapy, speech pathology, medical, social, and home health aide services. The following is a description of the agency from Lehigh Valley Health Network’s web site:

There’s no place like home when you’re recovering from an illness or injury. Yet you want the reassurance and care of highly skilled health care professionals. We give you both. We provide care when you don’t need to be in the hospital, but still require medical attention. Our team of health care professionals includes top-rated nurses, home health aides, social workers and rehabilitation therapists who help you recover as quickly as possible. We work closely with your doctor to ensure you get back on your feet as quickly as possible.

Our home care professionals offer the area’s most comprehensive and innovative programs. Here’s why our care stands out:

We have provided home health services to the Lehigh Valley community for nearly 50 years.

Our nurses and staff are highly educated and recognized for their skills and compassion. We also are recognized nationally for quality nursing care with the Magnet designation by the American Nurses Credentialing Center.

We use the latest technology and practices including telemedicine. When caregivers aren’t physically with you, we still can monitor your health. A home health monitoring system helps us track your blood pressure, heart rate and temperature. If we discover you may be uncomfortable, as indicated by changes in blood pressure, heart rate or temperature, a nurse will visit you as soon as possible to help you feel better.

We work closely with programs like OACIS (Optimizing Advanced Complex Illness Support) Services, which helps you and your family manage your care and ensure everyone understands your needs and goals.

Home care after childbirth

Having a baby is both exciting and challenging. If you have a condition such as diabetes, high blood pressure, heart disease, postpartum depression or pre-term labor, or if you need help managing your medication, your doctor may recommend you receive care in your home, where you are most comfortable. We provide specialized care to help you take care of yourself and your newborn.

After you and your newborn are home, a nurse will visit you to help you adjust to the changes in your life and ensure you get the support you need. A nurse can teach you and your family how to care for yourself and your newborn and answer any questions you may have about breastfeeding.

Home care for children

Children and adults require different care. So our specially educated pediatric nurses provide care in the home for children (newborns through age 18) who are born prematurely, are at high-risk for developing illnesses, already suffer from an illness or are recovering from an injury. We believe children heal better at home, surrounded by family.

Your child will have a special treatment plan designed by his or her physician and home health caregivers. This may include medical care, social services, nutrition and rehabilitation.

Home Health Care Agency / Lehigh Valley Home Care
Phone Number / 610-969-0300
Address / 2166 S. 12th St
Allentown, PA 18103
County / Lehigh
Nursing Services Offered
Behavioral health / Patient and family education
Catheter care / Psychosocial Support Services
Diabetes care and education / Patient assessment and monitoring
Diet instruction and nutritional support / Rehabilitation
Injections / Cardiac care
Medication monitoring / Wound care
Pain management / Symptom management

Other Services Offered:

Home health aide services, such as help with:

Bathing and personal hygiene
Dressing
Light meal preparation

Medical social services, including:

Counseling and education regarding long-term planning and available community resources
Short-term counseling to assist with adjustment to illness and use of support services

Rehabilitative therapies, such as:

Physical therapy to help with balance, movement, strength, prosthetics and walking
Occupational therapy to help with activities of daily living
Speech and language therapy to improve speech, language and cognitive function as well as help with swallowing problems

Employment Full Time Equivalent
Licensed Practical Or Vocational Nurses / 7.00
Registered Professional Nurses / 80.00
Occupational Therapists / 3.50
Physical Therapists / 19.00
Speech Pathologists Or Audiologists / 0.50
Home Health Aides / 10.00
Social Workers / 1.00

Certification Date

Lehigh Valley Home Care’s initial certification by Medicare was in 1966.

The Pennsylvania Department of Health conducts periodic surveys for home health agencies to ensure compliance with CMS and applicable Pennsylvania laws. The Joint Commission also performs random surveys. Home Care agencies in Pennsylvania must be licensed by the Department of Health.

Here are the results of the latest Pennsylvania Department of Health inspection performed on March 22, 2013:

Based on the findings of an unannounced Medicare recertification survey conducted 03/18/2013 through 03/22/2013, Lehigh Valley Home Care was found to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.
Based on the findings of an unannounced home health agency state licensure survey conducted 03/18/2013 through 03/22/2013, Lehigh Valley Home Care was found to be in compliance with the requirements of 28 Pa. Code, Part IV, Health Facilities, Subpart G. Chapter 601.
Based on the findings of an unannounced home health agency state licensure survey conducted 03/18/2013 through 03/22/2013, Lehigh Valley Home Care was found to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 51, Subpart A.

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Regulations

Licensing Procedures

Each home health care agency must submit an application to the state in which it will operate along with an application fee. Included in the application is a description of agency's organizational structure. The names of officers of the agency, its officers, the administrator, directors, partners, managers and those owning 10 percent or more of the home health care organization must be identified.

The service area must be identified along with the management plan and how the home health care professionals will be supervised to ensure quality medical care. If the home health care agency has affiliates or branch offices, it must provide the names and addresses of the affiliate locations. A complete description of the nursing services that will be provided must be identified along with a criminal background check of all health care providers. Home health care agencies must submit a copy of the current business license and proof of insurance that covers professional liability, public liability and property damage.

Federal Requirements

Federal requirements for a home health care organization is that it obtains a state license to operate and submit to a survey or an interview that consist of a visit to the corporate office of the home health care main office by the Department of Health employees.

Medicare requirements for home health care agencies include a state license, approval of the Department of Health, background check of all employees, proof of professional insurance and proof that the nursing staff is state licensed.

I’ve copied and condensed 42 CFR, Part 484

TITLE 42--Public Health

CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER G--STANDARDS AND CERTIFICATION

PART 484--HOME HEALTH SERVICES

Subpart A—General Provisions

§484.1Basis and scope.

§484.2Definitions.

§484.4Personnel qualifications.

Subpart B—Administration

§484.10Condition of participation: Patient rights.

The patient has the right to be informed of his or her rights. The HHA must protect and promote the exercise of these rights.

(a) Standard: Notice of rights.

(b) Standard: Exercise of rights and respect for property and person

(d) Standard: Confidentiality of medical records

(e) Standard: Patient liability for payment

(f) Standard: Home health hotline

§484.11Condition of participation: Release of patient identifiable OASIS information.

The HHA and agent acting on behalf of the HHA in accordance with a written contract must ensure the confidentiality of all patient identifiable information contained in the clinical record, including OASIS data, and may not release patient identifiable OASIS information to the public.

§484.12Condition of participation: Compliance with Federal, State, and local laws, disclosure and ownership information, and accepted professional standards and principles.

(a) Standard: Compliance with Federal, State, and local laws and regulations.

(b) Standard: Disclosure of ownership and management information.

§484.14Condition of participation: Organization, services, and administration.

Organization, services furnished, administrative control, and lines of authority for the delegation of responsibility down to the patient care level are clearly set forth in writing and are readily identifiable. Administrative and supervisory functions are not delegated to another agency or organization and all services not furnished directly, including services provided through subunits are monitored and controlled by the parent agency. If an agency has subunits, appropriate administrative records are maintained for each subunit.

(a) Standard: Services furnished.

(b) Standard: Governing body.

(d) Standard: Supervising physician or registered nurse.

(e) Standard: Personnel policies.

(f) Standard: Personnel under hourly or per visit contracts.

(g) Standard: Coordination of patient services.

(h) Standard: Services under arrangements.

(i) Standard: Institutional planning.

(j) Standard: Laboratory services

§484.16Condition of participation: Group of professional personnel.

A group of professional personnel, which includes at least one physician and one registered nurse (preferably a public health nurse), and with appropriate representation from other professional disciplines, establishes and annually reviews the agency's policies governing scope of services offered, admission and discharge policies, medical supervision and plans of care, emergency care, clinical records, personnel qualifications, and program evaluation. At least one member of the group is neither an owner nor an employee of the agency.

(a) Standard: Advisory and evaluation function.

§484.18Condition of participation: Acceptance of patients, plan of care, and medical supervision.

Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the patient's place of residence. Care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.

(a) Standard: Plan of care.

(b) Standard: Periodic review of plan of care.

§484.20Condition of participation: Reporting OASIS information.

HHAs must electronically report all OASIS data collected in accordance with §484.55.

(a) Standard: Encoding and transmitting OASIS data.

(b) Standard: Accuracy of encoded OASIS data.

(d) Standard: Data Format.

I’ve copied and condensed 28 Pa Code Part 4, Subpart F Chapter 601 and Subpart A Chapter 51

RULES AND REGULATIONS FORHOME HEALTH CARE AGENCIES

28 Pa. Code, Part IV, Health Facilities

Subpart F. Chapter 601 andSubpart A. Chapter 51

Chapter 601. HOME HEALTH CARE AGENCIES

GENERAL PROVISIONS

Sec.

601.1 Legal base.

601.2 Affected home health care agencies.

601.3 Requirements for home health agencies

601.4 Inspections

601.5 Exceptions

601.6 Definitions

601.7 Ownership

LICENSURE

601.11 Licensure process

601.12 Issuance of license

601.13 Responsibility of home health care agency owners

601.14 Reasons for revocations or non renewal of license

GOVERNANCE AND MANAGEMENT

601.21 Organization, services and administration

601.22 Agency evaluation and review

SERVICES

601.31 Acceptance of patients, plan of treatment and medical supervision.

601.32 Skilled nursing services.

601.33 Therapy services.

601.34 Medical and social services.

601.35 Home health aide services.

601.36 Clinical records.

CHAPTER 51. GENERAL INFORMATION

GENERAL PROVISIONS

Sec.

51.1. Legal base, scope and definitions.

51.2. Licensed facilities.

51.3. Notification.

51.4. Change in ownership; change in management.

51.5. Building occupancy.

51.6. Identification of personnel.

CIVIL RIGHTS

51.11. Civil rights compliance

51.12. Nondiscriminatory policy.

51.13. Civil rights compliance records.

RESTRICTION OF PROVISION OF HEALTH CARE SERVICES

51.21. Surgery.

51.22. Cardiac catheterization.

51.23. Positron emission tomography.

51.24. Lithotripsy.

EXCEPTIONS

51.31. Principle.

51.32. Exceptions for innovative programs.

51.33. Requests for exceptions.

51.34. Revocation of exceptions.

SANCTIONS

51.41. Violations, penalties.

Medical Record Items

Federal

CFR 484.18Condition of participation: Acceptance of patients, plan of care, and medical supervision.

(a) Standard: Plan of care.

(b) Standard: Periodic review of plan of care.

CFR 484.20Condition of participation: Reporting OASIS information.

HHAs must electronically report all OASIS data collected in accordance with §484.55.

(a) Standard: Encoding and transmitting OASIS data.

(b) Standard: Accuracy of encoded OASIS data.

(d) Standard: Data Format.

Chapter 7 of the Medicare Benefit Policy Manual covers Home Health Services.

Section 30.2 Services Are Provided Under a Plan of Care Established and Approved by a Physician

30.2.1 -Content of the Plan of Care

30.2.2 -Specificity of Orders

30.2.3 -Who Signs the Plan of Care

30.2.4 -Timeliness of Signature

30.2.5 -Use of Oral (Verbal) Orders

30.2.6 -Frequency of Review of the Plan of Care

30.2.7 -Facsimile Signatures

30.2.8 -Alternative Signatures

30.2.9 -Termination of the Plan of Care -Qualifying Services

30.2.10 -Sequence of Qualifying Services and Other Medicare Covered

State

28 Pa. Code, Part IV, Subpart F. Chapter 601, section 36 specifies the requirements for clinical documentation for Home Health Agencies.

§601.36. Clinical records.

(a) Maintenance and content of records

A clinical record containing pertinent past and current findings in accordance with accepted professional standards shall be maintained for every patient receiving home health care services. In addition to the plan of treatment—see §601.31(b)(relating to acceptance of patients, plan of treatment and medical supervision)—the record shall contain appropriate identifying information; name of physician; drug and dietary treatment; activity orders; signed and dated clinical and progress notes by the individual who delivered the service—clinical notes are written the day service is rendered and incorporated into the clinical record no less often than weekly; copies of summary reports sent to the physician; and a discharge summary.

(b) Retention of records

Clinical records shall be retained for 7 years after discharge of the patient. Policies shall provide for retention even if the home health agency discontinues operations. If the patient is transferred to another home health care agency, a copy of the record or abstract shall accompany the patient.

Information contained in the patient’s record shall be privileged and confidential. Clinical record information shall be safeguarded against loss or unauthorized use. Written procedures shall govern use and removal of records and conditions for release of information. The patient’s written consent shall be required for release of information outside the home health care agency, except as otherwise provided by law or third-party contractual arrangements.

Documentation

Example: Content of Plan of Care (Chapter 7 of the Medicare Benefit Policy Manual, Section 30.2.1)

The HHA must be acting upon a physician plan of care that meets the requirements of this section for HHA services to be covered. The plan of care must contain all pertinent diagnoses, including:

The patient's mental status;
The types of services, supplies, and equipment required;
The frequency of the visits to be made;
Prognosis;
Rehabilitation potential;
Functional limitations;
Activities permitted;
Nutritional requirements;
All medications and treatments;
Safety measures to protect against injury;
Instructions for timely discharge or referral; and
Any additional items the HHA or physician chooses to include.

If the plan of care includes a course of treatment for therapy services:

The course of therapy treatment must be established by the physician after any needed consultation with the qualified therapist;
The plan must include measurable therapy treatment goals which pertain directly to the patient’s illness or injury, and the patient’s resultant impairments;
The plan must include the expected duration of therapy services; and
The plan must describe a course of treatment which is consistent with the qualified therapist’s assessment of the patient’s function.

Reimbursement

Payment for home care services can be made by Medicare, Medicaid, and private insurance or self-pay. The majority of home care services are reimbursed by Medicare. Patients who are on Pennsylvania’s Medical Assistance (Medicaid) and are receiving long term care may claim home health services that are reimbursed at a rate set by the state legislature.

Medicare Home Health Prospective Payment System

The Balanced Budget Act of 1997, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) of 1999, called for the development and implementation of a prospective payment system (PPS) for Medicare home health services. The PPS proposed rule was published on October 28, 1999, with a 60-day public comment period, and the final rule was published on July 3, 2000.

Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country. The adjustment for the health condition, or clinical characteristics, and service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive. While payment for each episode is adjusted to reflect the beneficiary's health condition and needs, a special outlier provision exists to ensure appropriate payment for those beneficiaries that have the most expensive care needs. Adjusting payment to reflect the HHA's cost in caring for each beneficiary including the sickest, should ensure that all beneficiaries have access to home health services for which they are eligible.