Policy Manual sample

MDT Home Health Care Agency, Inc. § Homebound requirement is no longer met § Medical condition has stabilized § Physician orders are ended § Goals of care have been attained Expedited Appeal Notices NOT Required: § Some, but not all, services are terminated § Hospital or SNF transfer § Patient requests discharge § Patient moves out of service area § Unsafe patient situation § Patient is non-compliant § Unsafe situation for agency personnel § Patient death Exceptions to delivery rule that notice must be given at least 2 days before discharge: The two-day rule does not apply when patients are on services less than 2 days or in cases of unanticipated changes to coverage (physician orders d/c from services OR patient is absent from home). In these cases, give as soon as need to discharge is discovered. Notices in these cases (unexpected termination of coverage), may be mailed, rather than hand-delivered, following documented telephone notification to the patient. Detailed Notice Required if the QIO informs the HHA that a patient has requested an expedited appeal. Must be delivered the same business day. ABN is required when services are to be initiated, or are terminated in part or reduced outside of the parameters in the PoC. Dual Notices Both an expedited appeal notice and an ABN are required in cases where all services are determined to no longer be covered by Medicare, but the beneficiary’s physician has ordered continued services. Kepro, Florida’s QIO, has established a separate section to deal with the ED process HHAs are to implement. "Fast Track Appeals" helpline: 1-844-455-8708. This is the number that we put on the notice for the patients to call if they want to appeal a termination based on lack of Medicare coverage of the services. (Our Agency also put this TTY/TDD number (1-855-843-4776) on the first/second page of the notice.) Home Health Agency Policies A-196