Consent Forms

Quick question to the group: I sat with a surveyor today that stated there should be a new service agreement every time a new discipline is added. Example: we did a SOC on a nursing only case, the nurse later rec’d orders to add therapy. Per the surveyor, we should have gotten a new service agreement. I disagree with this practice. What are you doing at your office? Thanks!

Comments

  • edited May 2017
    What is in your service agreement? We don’t have an actual form we call a service agreement.
    Diana Yoesel
  • edited May 2017
    That is not our practice. I think we are correct under the current (until
    July) COPs. If you are documenting that the patient participates in the
    planning of changes, I think you should be okay under current regs.

    I cannot comment on the new ones coming because I'm not as prepared as I
    should be.

    I'm not sure where the surveyor is focusing, but look at
    https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf

    Pages 14-16
    Some excerpts are:
    §484.10(c) Standard: Right to be Informed and to Participate in
    Planning Care and Treatment
    ______________________________________________________________________
    G108
    (1) The patient has the right to be informed, in advance, about the care to
    be
    furnished, and of any changes in the care to be furnished.
    (i) The HHA must advise the patient in advance of the disciplines that will
    furnish care, and the frequency of proposed visits.
    (ii) The HHA must advise the patient in advance of any change in the plan of
    care before the change is made.
    ______________________________________________________________________
    G109
    (2) The patient has the right to participate in the planning of the care.
    (i) The HHA must advise the patient in advance of the right to participate
    in
    planning the care or

    ............
    Probes §484.10(c)
    1. What documentation in the clinical records indicates that the HHA
    advised the
    patient, in advance, of his or her right to participate in planning the
    care or treatment
    to be provided? What documentation indicates that the HHA informed the
    patient
    about the types of services to be provided, the disciplines involved, the
    frequency of
    the services, and the anticipated outcomes?
    2. How does the HHA inform the patient about changes in the plan of care
    and solicit the
    patient’s participation prior to the change being implemented?
    3. How does the agency advise patients of the need for the physician to
    agree with the
    plan of treatment and with any changes to that plan?



    Daniel P. Clark, RN
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  • Our Agency has a Service Agreement Addendum that added disciplines use. You may not know that a discipline will be added until further down the road. The patient must be informed of this change in the plan of care and agree (participate) to it prior to implementation. Per ACHC guidelines, there must be a discipline, service description, and frequency range, along with frequency of supervisory visits for that discipline.

    If you have no addendum, then there needs to be documentation in the clinical record that this change in plan of care was discussed with the pt.
  • edited May 2017
    A properly worded written addendum signed by the patient would definitely
    prove you had that discussion. That might even be safest and therefore
    best. But I still don't think it's required.

    From my previous link, page 15:
    Ask the patient how he or she participated in developing the plan of care
    to be furnished
    by the HHA and when he/she was told about changes in the plan of care. The
    HHA may
    discuss changes with the patient by telephone prior to the HHA visit or at
    the time of the
    visit, but the patient should feel that he or she has time to consider the
    implications of the
    change(s) and concur or object to them prior to implementation.


    Daniel P. Clark, RN
    This email may contain privileged and confidential information which is
    covered under HIPAA and other privacy laws. If you have received this in
    error, please return to the sender. If you must forward the information,
    please bear in mind that all individuals and companies are responsible for
    maintaining privacy standards.
  • edited May 2017
    Check your state regs. Some states require the patient to be informed orally and in writing of changes.
  • edited May 2017
    Great point Susan, I should have thought of that.

    Daniel P. Clark, RN
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