Policy Manual sample

MDT Home Health Care Agency, Inc. NOTICE ON NON COVERAGE, EXPEDITE DETERMINATION PROCESS DISCHARGE OF PATIENTS (Medicare Beneficiaries) Medicare and Medicare HMO patient's are issued a Notice of Medicare Non-Coverage (NOMNC) at least 48 hours prior of termination of Home Health Services, or the second to last day of service if care is not being provided daily, which explains the patients' right to an immediate independent review of the proposed discontinuation of services. Policy for Expedited Determination (ED) Process At least 2 days prior to discharge from services, or the second to last day of service if care is not being provided daily, the patient will receive an Advance Notice of Discharge (for Medicare Patients “A NOTICE OF MEDICARE NON COVERAGE”) with the anticipated discharge date unless the patient or their representative requests discharge or the patient moves to a “higher” level of care, such as ICF, SNF, acute hospital bed, etc. · In the event that it is not possible to personally deliver the Advance Notice, the patient or their representative will be called and informed of the impending discharge, this will be documented in the Agency clinical record, and the completed form will be mailed to the patient or their representative. In some situations, it will not be possible to deliver the Advance Notice 2 or more days before discharge, such as when Agency staff discover the patient is driving and determine that the patient is not homebound. In this event, the patient will receive the completed Advance Notice at the time of discovery. If the QIO notifies Agency staff that a patient has requested an ED, staff members will present patient with a completed Detailed Notice of Discharge and will comply with the state QIO records request by close of the business day. The Agency will maintain a copy of any Advance or Detailed Notice of Discharge When to use Expedited Determination (ED) Generic Form, ED Detail Form and/or ABN · Form must be filled out to be considered valid. If there are blanks not filled in, it will need to be redone with a new discharge date 2 days in the future. Give at least 2 days before discharge (if they are not seen that often, can give notice next to last visit i.e. weekly visits patient). If patient is incompetent, issue form to his authorized representative. If the patient or their representative will not sign, date and sign and document on the form that they will not sign and leave a copy with them. If the patient files a notice with the QIO for an expedited appeal, our Agency must fill out and give them a Detailed Notice (and bring back the copy) that same business day. Expedited Appeal Notices Required for these discharges: (Note - if services are still physician ordered, a HHA must also issue an ABN form) Treatments are no longer medically necessary or reasonable § Teaching has been completed Home Health Agency Policies A-195