TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER b: HOSPITALS AND AMBULATORY CARE FACILITIES
PART 245 HOME HEALTH, HOME SERVICES, AND HOME NURSING AGENCY CODE
SECTION 245.200 SERVICES HOME HEALTH
Section 245.200 Services – Home Health
a) Each home health agency shall provide skilled nursing service and at least one other home health service on a part-time or intermittent basis. The agency staff shall directly provide basic skilled nursing service. The agency staff may provide other home health services directly or through a contractual purchase of services. Additional skilled specialty nursing services and use of additional nursing staff to meet changes in caseload may be provided by contract. All services shall be provided in accordance with the orders of the patient's physician or podiatrist, under a plan of treatment established by the physician or podiatrist, and under the supervision of agency staff.
b) The agency shall state in writing what services will be provided directly and what services will be provided under contractual arrangements.
c) Services provided under contractual arrangements shall be through a written agreement that includes, but is not limited to, the following:
1) A detailed description of the services to be provided;
2) Provision for adherence to all applicable agency policies and personnel requirements, including requirements for initial health evaluations and employee health policies;
3) Designation of full responsibility for agency control over contracted services;
4) Procedures for submitting clinical and progress notes;
5) Charges for contracted services;
6) Statement of responsibility of liability and insurance coverage;
7) Period of time in effect;
8) Date and signatures of appropriate authorities; and
9) Provision for termination of services.
d) Acceptance of Patients. Patient acceptance and discharge policies shall include, but not be limited to, the following:
1) Persons shall be accepted for health services on a part-time or intermittent basis in accordance with a plan of treatment established by the patient's physician or podiatrist. This plan shall be promulgated in writing within 14 days after acceptance and signed by the physician within 30 days after the start of the care date.
2) Prior to acceptance of a patient, the agency shall inform the person of the agency's charges for the various services that it offers.
3) No person shall be refused service because of age, race, color, sex, marital status, national origin or source of payment. An agency is not required to accept a patient whose source of payment is less than the cost of services.
4) 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.
5) When services are to be terminated by the home health agency, the patient is to be notified three working days in advance of the date of termination, stating the reason for termination. This information shall be documented in the clinical record. When any continuing care is indicated, a plan shall be developed or a referral made.
6) Services shall not be terminated until the registered nurse, or the appropriate therapist, or both, in consultation with the patient's physician or podiatrist, consider termination appropriate or arrangements are made for continuing care.
e) Plan of Treatment
Skilled nursing and other home health services shall be in accordance with a plan based on the patient's diagnosis and an assessment of the patient's immediate and long-range needs and resources. The plan of treatment is established in consultation with the home health services team, which includes the patient's physician or podiatrist, pertinent members of the agency staff, the patient, and members of the patient's family. The plan of treatment shall include:
2) Functional limitations and rehabilitation potential;
3) Expected outcomes for the patient;
4) The patient's physician's or podiatrist's regimen of:
E) Specific procedures considered essential for the health and safety of the patient;
F) Mental status;
G) Frequency of visits;
H) Equipment required;
I) Instructions for timely discharge or referral; and
J) Assessed need for influenza and pneumococcal vaccination;
5) The patient's physician's or podiatrist's signature and date.
f) Consultation with the patient's physician or podiatrist on any modifications in the plan of treatment deemed necessary shall be documented, and the patient's physician's or podiatrist's signature shall be obtained within 30 days after any modification of the medical plan of treatment.
1) The home health services team shall review the plan every 62 days, or more often if the patient's condition warrants.
2) An updated plan of treatment shall be given to the patient's physician or podiatrist for review, for any necessary revisions, and for signature every 62 days, or more often as indicated.
g) Patient Care Plan
1) Home health services from members of the agency staff, as well as those under contractual arrangements, shall be provided in accordance with the plan of treatment and the patient care plan. The patient care plan shall be written by appropriate members of the home health services team based upon the plan of treatment and an assessment of the patient's needs, resources, family and environment. A registered nurse shall make the initial assessment. Assessment by other members of the health services team shall be made on orders of the patient's physician or podiatrist or by request of a registered nurse. If the patient's physician has ordered only therapy services, the appropriate therapist (physical therapist, speech-language pathologist or occupational therapist) may perform the initial assessment.
2) The patient care plan shall be updated as often as the patient's condition indicates. The plan shall be maintained as a permanent part of the patient's record. The patient care plan shall indicate:
A) Patient problems;
B) Patient's goals, family's goals, and service goals;
C) Service approaches to modify or eliminate problems;
D) The staff responsible for each element of service;
E) Anticipated outcome of the service approach with an estimated time frame for completion; and
F) Potential for discharge from service.
h) Clinical Records
1) Each patient shall have a clinical record, identifiable for home health services and maintained by the agency in accordance with accepted professional standards. Clinical records shall contain:
A) Appropriate identifying information for the patient, household members and caretakers, medical history, and current findings;
B) A plan of treatment signed by the patient's physician or podiatrist;
C) A patient care plan developed by the home health services team in accordance with the patient's physician's or podiatrist's plan of treatment;
D) A noted medication list with dates reviewed and revised and date sent to the patient's physician or podiatrist;
E) Initial and periodic patient assessments by the registered nurse that include documentation of the patient's functional status and eligibility for service;
F) Assessments made by other members of the home health services team;
G) Signed and dated clinical notes for each contact that are written the day of service and incorporated into the patient's clinical record at least weekly;
H) Reports on all patient home health care conferences;
I) Reports of contacts with the patient's physician or podiatrist by patient and staff;
J) Indication of supervision of home health services by the supervising nurse, a registered nurse, or other members of the home health services team;
K) Written summary reports sent to the patient's physician or podiatrist every 62 days, containing home health services provided, the patient's status, recommendations for revision of the plan of treatment, and the need for continuation or termination of services;
L) Written and signed confirmation of the patient's physician's or podiatrist's interim verbal orders;
M) A discharge summary giving a brief review of service, patient status, reason for discharge, and plans for post-discharge needs of the patient. A discharge summary may suffice as documentation to close the patient record for one-time visits and short-term or event-focused or diagnoses-focused interventions. The discharge summary need not be a separate piece of paper and may be incorporated into the routine summary of reports already furnished to the physician; and
N) A copy of appropriate patient transfer information, when requested, if the patient is transferred to another health facility or health agency.
2) For record keeping, the agency may utilize hard copies or an electronic format. Each agency shall have written policies and procedures for records maintenance and shall retain records for a minimum of five years beyond the last date of service provided. These procedures may include that the agency will use and maintain faxed copies of records from licensed professionals, rather than original records, provided that the faxed copies shall be maintained on non-thermal paper and that the original records shall be maintained for a period of five years by the professional who originated the records. If the professional is providing services through a contract with the agency, then the contract shall include that the professional shall maintain the original records for a period of five years.
3) Agencies that are subject to the Local Records Act should note that, except as otherwise provided by law, no public record shall be disposed of by any officer or agency unless the written approval of the appropriate Local Records Commission is first obtained. (Section 7 of the Local Records Act)
4) Each agency shall have a written policy and procedure for protecting the confidentiality of patient records that explains the use of records, removal of records and release of information.
5) Agencies that maintain client records by computer rather than hard copy may use electronic signatures. The agency shall develop policies and procedures governing these entries and the appropriate authentication and dating of electronic records. Authentication may include signatures, written initials, or computer-secure entry by a unique identifier or primary author who has received and approved the entry. The agency shall enact safeguards to prevent unauthorized access to the records and shall draft a process for reconstruction of the records if the system fails or breaks down.
i) Drugs and Biologicals. The agency shall have written policies governing the supervision and administration of drugs and biologicals that shall include, but not be limited to, the following:
1) All orders for medications to be given shall be dated and signed by the patient's physician or podiatrist.
2) Drugs and treatments shall be administered by agency staff only as ordered by the physician, with the exception of influenza and pneumococcal polysaccharide vaccines, which may be administered per agency policy developed in consultation with a physician, and after an assessment of the patient.
3) All orders for medications shall contain the name of the drug, dosage, frequency, method or site of injection, and permission from the patient's physician or podiatrist if the patient, the patient's family, or both are to be taught to give medications.
4) The agency's physician or podiatrist or registered nurse shall check all medicines that a patient may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindicated medications, and shall promptly report any problem to the patient's physician or podiatrist.
5) All verbal orders for medication or change in medication orders shall be taken by the nurse, written, and signed by the patient's physician or podiatrist within 30 days after the verbal order.
6) When any experimental drug, sera, allergenic desensitizing agent, penicillin or other potentially hazardous drug is administered, the registered nurse administering the drugs shall have an emergency plan and any drugs and devices that may be necessary if a drug reaction occurs.
j) Evaluation. The home health agency shall have written policies for evaluation and shall make an overall evaluation of the agency's total program at least once a year. This evaluation shall be made by the Professional Advisory Group (or a committee of this group), home health agency staff, consumers, or representation from professional disciplines that are participating in the provision of home health services. The evaluation shall consist of an overall policy and administrative review and a clinical record review. The evaluation shall assess the extent to which the agency's program is appropriate, adequate, effective and efficient. Results of the evaluation shall be reported and acted upon by those responsible for the operation of the agency and maintained separately as administrative records.
k) Policy and Administrative Review. As a part of the evaluation process, the policies and administrative practices of the agency shall be reviewed to determine the extent to which they promote patient care that is appropriate, adequate, effective and efficient. Mechanisms shall be established in writing for the collection of pertinent data to assist in evaluation. The data to be considered may include, but are not limited to: number of patients receiving each service offered; number of patient visits; reasons for discharge; breakdown by diagnosis; sources of referral; number of patients not accepted, with reasons; and total staff days for each service offered.
l) Clinical Record Review
1) At least quarterly, members of professional disciplines representing at least the scope of the agency's programs shall review a sample of both active and closed clinical records to assure that established policies are followed in providing services (direct, as well as those under contractual arrangement). This review shall include, but not be limited to, whether the:
A) Patient care plan was directly related to the stated diagnosis and plan of treatment;
B) Frequency of visits was consistent with the plan of treatment; and
C) Services could have been provided in a shorter span of time.
2) Clinical records shall be reviewed continually for each 62-day period that a patient received home health services to determine the adequacy of the plan of treatment and the appropriateness of continuing home health care.
(Source: Amended at 39 Ill. Reg. 16406, effective December 10, 2015)