CoP Educational Series Part 4: Subpart B – Patient Rights

Posted on Wednesday, July 12, 2017 4:16 PM

This is the second of two posts covering Subpart B – Patient Care.  In this post I will focus on the CoPs regarding Patient Rights.

484.50 Condition: Patient Rights states that the patient and their representative, if any, have the right to be informed of all patient rights in a language and manner the individual understands. The home health agency must protect and promote the exercise of these rights.

Many of the old standards from the current CoPs regarding Patient Rights have been reorganized and revised and even expanded upon. In addition, some new standards have been added. Overall, given the number of changes, Patient Rights is like a new CoP. The patient rights CoP is divided into six separate standards:  Notice of Rights, Exercise of Rights, Rights of the Patient (significantly modified), Transfer and Discharge (new standard), Investigation of Complaints (new standard) and Accessibility (new standard).  Each standard will be discussed in detail.

a) Standard – Notice of Rights requires a home health agency to provide the patient and the patient’s legal representative the following information on the initial evaluation visit, prior to providing care to the patient – a) written notice of the patient’s rights and responsibilities, b) the agencies transfer and discharge policies, c) the home health agency Administrator’s contact information and d) an OASIS privacy notice. The patient and any legal representative of the patient has the right to be informed of the patient’s rights in a manner they understand. The written notification must be presented in a manner that is understandable by individuals that have a limited English proficiency and accessible to those with disabilities. Receipt of the written notifications must be confirmed by patient or the patient’s legal representative. Also, by the completion of the second visit by a skilled professional, the patient must be provided with a verbal notice in the patient’s primary or preferred language and in a manner or format they understand. The agency may use an interpreter if necessary, although the patient can’t be charged for this service. Lastly, any patient designated representative must be presented the written notifications of the patient’s rights and responsibilities, including the agency transfer and discharge policies within 4 business days of the initial evaluation visit.

b) Standard – Exercise of Rights. Due to concerns across various state regulations with regards to the definition of “incompetent” this term has been removed. The revised CoPs state if the patient “has been ajudged to lack the legal capacity to make health care decisions as established by state law. If this is the case, and the court has appointed an individual to act on the person’s behalf, this individual may exercise the patient’s rights. In the event an agency is caring for a patient that has been ajudged to lack the legal capacity to make health care decisions, a copy of the court order should be obtained to verify the authority of the legal representative and for further reference.

c) Standard – Rights of the Patient is not a new standard. It has had significant revisions, so seems like a new standard. Each listed in the standard will be discussed in brief with all new and revised language highlighted.
Patients have the right to his or her property and person to be treated with respect.

Be free from verbal, mental, sexual and physical abuse, including injuries of unknown source, neglect and misappropriation of personal property. This is a new requirement within this standard, as the previous CoPs did not expressly address this right.

The right to make complaints regarding care or lack thereof. In addition, the patient has the right to be advised of the state toll free home health hot-line, it’s phone number, contact information and hours of operation and it purpose to receive complaints and questions regarding local home health agencies.

The patient also has the right to participate in, be informed and consent to or refuse care and or any treatments with respect to the completion of the comprehensive assessment as well as all other assessments. The same rights apply to the creation of the plan of care and any revisions in the plan of care including the disciplines seeing the patient and the frequency of their visits and the expected outcomes of the goals and interventions being planned, along with risks and benefits of the care. The patient has the right to receive all services outlined in the plan of care. Overall the patient’s involvement in the plan of care is a significant focus.

In addition, to the above rights the patient has a right to a confidential medical record. Revisions were made to this standard regarding access to and/or the release of information to conform with HIPAA Privacy regulations.

A patient has always had the right to be advised of payment for services from federal payors or the patient themselves. This standard has been revised slightly, although home health agencies have always been responsible to inform the patient of any potential liability for services they receive. A new standard does require the home health agency provides in writing to the patient notification of any services the home health agency believes may not be covered or in advance of reducing and/or terminating the patient’s care.

The patient also has the right to be advised of the state toll-free hotline number, contact information and the hours of operation and the purpose of receiving complaints or answering questions regarding area home health agencies. In addition to providing this information, a new standard states home health agencies are now required to provide the names, addresses, and contact information on the following federally and state funded agencies in the patient’s area: 1. Agency on Aging 2. Center for Independent Living, 3. Protection and Advocacy Agency, 4. Aging and Disability Resource Center, and 5. Quality Improvement Organization.

The patient also has the right to be free of any discrimination or reprisal for exercising any of his/her rights.

Lastly, a new standard outlines the patient’s rights to access auxiliary aides and language and must be informed on how to access these services.

Every patient being cared for in home health has always had rights. The newly revised CoPs enhance those rights for the protection of the patient.

The next post in the Home Health CoPs series will cover the remainder of 484.50 including Transfer and Discharge, Investigation of Complaints and Accessibility.

Written by Peggy Patton, Vice President of Education Services

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