Clinical, Rehab, & Regulatory Committee Survey Watch Group

More than 40 members, representing 32 agencies attended the 2^nd Survey Watch Group, hosted by the CRR Committee. Agencies shared their recent survey experience and provided details on what they learned during the process.

One question that members needed clarified was whether DME providers need to follow the CMS vaccination mandate. MHCA reached out to MDH for clarification. QSO-22-07 for Home Health and Hospice includes a definition for staff that need to meet the mandate.

“Staff” refers to individuals who provide any care, treatment, or other services for the home health agency/hospice and/or its patients, including employees; licensed practitioners; adult students, trainees, and volunteers; and individuals who provide care, treatment, or other services for the home health agency/hospice and/or its patients, under contract or other arrangement. This also includes individuals under contract or arrangement with the home health agency/hospice, including hospice and dialysis staff, physical therapists, occupational therapists, mental health professionals, licensed practitioners, or adult students, trainees or volunteers. Staff would not include anyone who provides only telemedicine services or support services outside of the home health agency/hospice and who does not have any direct contact with patients and other staff specified in paragraph (d)(1).

There may be many infrequent services and tasks performed in or for a HHA that is conducted by “one-off” vendors, volunteers, and professionals. HHAs are not required to ensure the vaccination of individuals who very infrequently provide ad hoc non-healthcare services (such as annual elevator inspection), services that are performed exclusively off-site, not at or adjacent to any site of patient care (such as accounting services), but they may choose to extend COVID-19 vaccination requirements to them if feasible. HHAs should consider the frequency of presence, services provided, and proximity to patients and staff.

With taking that into consideration, MDH has stated that, in general, DME providers would NOT be considered staff if they do not have direct contact with patients. One exception to this would be in situations where the DME vendor is delivering supplies to the patient’s house, going inside, setting up the equipment, and providing education to the patient on how to use the equipment. MDH has stated that in these cases, an agency will need to have a process in place for how they will ensure contracted staff are complaint with the vaccination requirement.

Another agency shared the following items assessed during a State Survey the previous week:

• The surveyors focused on therapy for co-visits. They scheduled these with multiple therapists (PT/OT), and asked questions about how a therapist reconciles and reviews medications in the home and Assisted Living Facilities.
• Requested contracted staff employee files. They were specifically looking at background study, TB testing, and vaccination status.
• Reviewed records of discharged clients. When doing this, they looked for communication of a discharge summary to providers.
• Interviewed multiple staff members on HHA, OTA, PTA, and LPN supervision. They also looked at how this agency manages, trains, and collaborates with contracted staff such as therapy.
• They looked at their medication reconciliation process, how they handled noncompliance with medications, discrepancies, and interactions.
• When reviewing employee records, they wanted to look further into Home Health Aide records in comparison to other disciplines. They looked at competency evaluations of Home Exercise Programs, Alzheimer training certificates and records that the aides meet the annual training requirement. If an aide does not have a CNA certificate, they wanted to know how they were comped on all the requested competency evaluations.
• Vaccine Mandate- they requested policy and requirements for unvaccinated staff and requested the vaccination/exemption status of all employees. The surveyors asked to see proof of weekly testing (for those that had an exemption as required by this agencies policy) and/or vaccination information was requested for selected employee records.  They also wanted to know how the care team knows the vaccination status of clients.
• Evaluated how complaints and vulnerable adult issues are addressed.
• Other items they looked for compliance with include:
  • The COVID-19 screening/infection control process.
  • Manufacturer’s instructions for disinfection for equipment (for example, an INR machine).
  • Orders for all services provided.
  • Service agreements and ABN/NOMNC forms.

The CRR group plans to hold another meeting on Thursday 6/30 at 1pm. This is a free event, and all members are welcome to attend! Register here.