A facility or program licensed, certified or otherwise authorized pursuant to state and federal laws to provide health care services patients’ homes. The services could be medical, therapeutic or other health services. The agency is responsible for supervising the delivery of these services under a plan prescribed and approved in writing by the Attending Physician.

Yes, a license is required authorizing a person or business to engage in the provision of home health services. The license is issued by the Texas Department of Aging and Disability Services (DADS). Home Health Agencies are referred to as Home and Community Support Agencies (HCSSA) by the DADS.

No, A Home Health Agency may be a public, nonprofit or proprietary agency or a subdivision of such an agency or organization.

• Public agency is an agency operated by a State or local government. Examples include State-operated HHAs and county hospitals. For regulatory purposes, "public" means "governmental."
• Nonprofit agency is a private (i.e., nongovernmental) agency exempt from Federal income taxation under §501 of the Internal Revenue Code of 1954. These HHAs are often supported, in part, by private contributions or other philanthropic sources, such as foundations. Examples include the nonprofit visiting nurse associations and Easter seal societies, as well as nonprofit hospitals.
• Proprietary agency is a private, profit-making agency or profit-making hospital.

Yes, there is a non-refundable initial license fee of $1750.00. A certified check, money order, or personal check must be made out to the Department of Aging and Disability Services (DADS).

Initial applicants should anticipate the review of the application and issuing of the license will be completed within 120 days from the date the application is received in the licensing section of DADS.

The Department of Aging and Disability Services may DADS may deny the issuance of a license to an applicant if the applicant, a controlling person of the applicant, a person with a discloseable interest, an affiliate of the applicant, an administrator, or an alternate administrator:

• at the time of application:
  • has been convicted of:
    • a crime listed in Health and Safety Code, §250.006 (relating to Convictions Barring Employment) within the time frames described in that section; or
    • a crime listed in section §97.223 of the Licensing Standards for Home and Community Support Services Agencies
  • has an unsatisfied final judgment in any state or other jurisdiction;
  • is in default on a guaranteed student loan
  • is delinquent on child support obligations ;
• for two years preceding the date of application, has a history in any state or other jurisdiction of any of the following:
  • an unresolved federal or state tax lien;
  • an eviction involving any property or space used as an inpatient hospice agency; or
  • an unresolved final Medicare or Medicaid audit exception; or
• for twelve months preceding the date of application, has a history in any state or other jurisdiction of any of the following:
  • denial, suspension, or revocation of an agency license or a license for a health care facility;
  • surrendering a license before expiration or allowing a license to expire instead of the licensing authority proceeding with enforcement action;
  • a Medicaid or Medicare sanction or penalty relating to the operation of an agency or a health care facility;
  • operating an agency that has been decertified in any state under Medicare or Medicaid; or
  • debarment, exclusion, or involuntary contract cancellation in any state from Medicare or Medicaid.

An agency's place of business must be located in and have an address in Texas. An agency located in another state must receive a license as a parent agency in Texas to operate as an agency in Texas.

Most new home health agencies start from the homes of the owners because it is cheaper. If you choose to start from your home, you want to make sure your home owners’ association is ok with it. Should you decide to start from your home, you are required to have an area (preferably a room in your home) designated as the office of your home health agency. If you wish to pursue the Licensed and Certified (L&C), license you will be advised to secure office space because of the requirement to be accredited by JCAHO, CHAP or ACHC.

• An applicant should contact the DADS office to request an application packet. DADS may be contacted by phone at 512-438-2622. An applicant may also call Axxess HealthCare at 214-575-7711. We will obtain application materials and our knowledgeable consultants will walk you through the whole licensing process, up to Medicare certification and Accreditation by JCAHO, CHAP or ACHC.
• An applicant must complete and furnish all documents and information that DADS requests in accordance with instructions provided with the application packet. All submitted documents must be notarized copies or originals.
• Upon receipt of an application packet and license fee, DADS reviews the material to determine whether it is complete and correct. A complete and correct application packet includes all documents and information that DADS requests as part of the application process. If DADS receives a partial fee, the application packet and monies are returned to the applicant.
• If an applicant decides not to continue the application process for an initial license after submitting the application packet and license fee, the applicant must submit to DADS a written request to withdraw the application. DADS does not refund the license fee.
• If an applicant receives a notice from DADS that some or all of the information required by this section is missing or incomplete, the applicant must submit the required information no later than 30 days after the date of the notice. If an applicant fails to submit the required information within 30 days after the notice date, DADS considers the application packet incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.
• An applicant who has requested the category of licensed and certified home health services on the initial license application must also make an application for certification by CMS as a Medicare-certified agency under the Social Security Act, Title XVIII.
  • Pending approval by CMS, the applicant:
    • receives an initial license reflecting the category of licensed home health services if the applicant meets the criteria for a license; and
    • complies with the Medicare conditions of participation for home health agencies in 42 Code of Federal Regulations, Part 484, as if the applicant were dually certified.
  • If CMS certifies an agency to participate in the Medicare program during the initial license period, DADS sends a notice to the agency that the category of licensed and certified home health services has been added to the license. If the agency wants to delete the licensed home health services category once the category of licensed and certified home health services has been added, the agency must submit a written request for deletion of that category.
  • If CMS denies certification to an applicant or if the applicant withdraws the application for participation in the Medicare program, the agency may retain the category of licensed home health services.

REQUIRED DOCUMENTS

• Form 2021, Application for Home and Community Support Services Agency, with nonrefundable fee Affidavit of Statement of Financial Solvency
• Affidavit the applicant is capable of meeting the minimum licensing standards
• Plan that provides for the orderly transfer of client care if the applicant cannot maintain delivery of home health, hospice, or personal assistance services
• Current resumes for administrator, alternate administrator, supervising nurse, alternate supervising nurse
• Form 2022, HCSSA Licensure Criminal History Check, for all owners, administrators, alternate administrators, and chief financial officers
• Form 2023 HCSSA Application for Medicare Certified Branch (if applicable)
• Current Letter of Good Standing from the State Comptroller of Public Accounts if a corporation or limited liability company; or an affidavit that the tax owed to the State under Chapter 171 of the Tax Code, is not delinquent or the exemption letter for the taxes from the State Comptroller's Office if nonprofit.
• Job description of personnel qualifications for administrator, alternate administrator, supervising nurse, and alternate supervising nurse
• Plan for providing continuing training and education for personnel during the term of the license
• Compliance record in other states for Medicare enrollment applicants
• Organizational structure of the agency denoting lines of authority down to and including the patient care level. The document may be either in the form of a chart or a narrative. The description must include:
  • all services provided by the agency;
  • the governing body, the administrator, the supervising nurse, advisory committee, interdisciplinary team, and staff, as appropriate, based on services provided by the agency; and
  • the lines of authority and the delegation of responsibility down to and including the client care level.
• CMS 1561 Health Insurance Benefit Agreement (four copies with original signatures) for all applicants for Medicare enrollment (PDF format)
• CMS 417 Hospice Request for Certification in the Medicare Program (four copies with original signatures) if requesting the category of Hospice
• Required documents from the Office of Civil Rights if requesting Medicare certification
• Attendance certificates from HCSSA presurvey conference for administrator, alternate administrator, supervising nurse, and alternate supervising nurse.

No, you do not. However your management personnel must include an administrator and a director of nursing. Administrator Qualifications

• For an agency licensed to provide licensed home health services, licensed and certified home health services, or hospice services, the administrator and the alternate administrator must:
  • be a licensed physician, registered nurse, licensed social worker, licensed therapist, or licensed nursing home administrator with at least one year of management or supervisory experience in a health-related setting, such as:
    • a home and community support services agency;
    • a hospital;
    • a nursing facility;
    • a hospice;
    • an outpatient rehabilitation center;
    • a psychiatric facility;
    • an intermediate care facility for persons with mental retardation or related conditions; or
    • a licensed health care delivery setting providing services for individuals with functional disabilities; or
  • have a high school diploma or a general equivalency degree (GED) with at least two years of management or supervisory experience in a health-related setting, such as:
    • a home and community support services agency;
    • a hospital;
    • a nursing facility;
    • a hospice;
    • an outpatient rehabilitation center;
    • a psychiatric facility;
    • an intermediate care facility for persons with mental retardation or related conditions; or
    • a licensed health care delivery setting providing services for individuals with functional disabilities.
• For an agency licensed to provide only personal assistance services, the administrator and the alternate administrator must meet at least one of the following qualifications:
  • have a high school diploma or a GED with at least one year experience or training in caring for individuals with functional disabilities;
  • have completed two years of full-time study at an accredited college or university in a health-related field; or
  • meet the qualifications listed in paragraph (1)(A) or (B) of this subsection.

Administrator Conditions.

• An administrator and alternate administrator must be able to read, write, and comprehend English.
• An administrator and alternate administrator must meet the requirements on the administration of an agency in TAC 40 §97.259 relating to Training in Administration of Agencies

Supervising Nurse Qualifications

• For an agency without a home dialysis designation, a supervising nurse and alternate supervising nurse must each:
  • be a registered nurse (RN) licensed in Texas or in accordance with the Board of Nurse Examiners rules for Nurse Licensure Compact (NLC); and
  • have at least one year experience as an RN within the last 36 months.
• For an agency with home dialysis designation, a supervising nurse and alternate supervising nurse must each:
  • be an RN licensed in Texas or in accordance with the Board of Nurse Examiners rules for NLC, and:
    • have at least three years current experience in hemodialysis; or
    • have at least two years experience as an RN and hold a current certification from a nationally recognized board in nephrology nursing or hemodialysis; or
  • be a nephrologist or physician with training or demonstrated experience in the care of ESRD clients.

Medicare is the largest payer of home health care and provides 100% coverage for qualified beneficiaries.

Essentially, all Americans are eligible for Medicare when they turn 65. There is an initial enrollment period for seven months after one's 65th birthday, when one can enroll in Medicare for free. After the enrollment period, someone who decides he wants Medicare may be subject to enrollment fees and penalties. People with disabilities and end-stage renal disease who are under 65 may be eligible for medicare.

A patient with Medicare may receive home health care benefits if the following conditions are met.

• Patient’s doctor decides that there is a need for medical care at home make a plan for your care at home.
• Patient needs at least one of the following: intermittent skilled nursing care, or physical therapy, or speech-language therapy, or continue to need occupational therapy.
• The home health agency must be approved by the Medicare program (Medicare-certified).
• Patient must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious service. A need for adult day care does not keep a patient from getting home health care.

Eligibility is also based on the amount of services a person needs Medicare covers home health services for as long as a person is eligible and the person’s doctor says the services are needed. However, the skilled nursing care and home health aide services are only covered on a part-time or “intermittent” basis. This means there are limits on the number of hours per day and days per week that a person can get skilled nursing or home health aide services. Therapy services don’t have to be part-time or intermittent. To decide whether or not a person is eligible for home health care, Medicare defines part time or “intermittent” as skilled nursing care that is needed or given on fewer than seven days each week or less than eight hours each day over a period of 21 days (or less) with some exceptions in special circumstances.

If you meet all four of the conditions for home health care listed above, Medicare will cover:

• skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
• home health aide services on a part-time or intermittent basis. A home health aide doesn’t have a nursing license. The aide provides services that give additional support to the nurse. These services include help with personal care such as bathing, using the bathroom, or dressing. These types of services don’t need the skills of a licensed nurse. Medicare doesn’t cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.
• physical therapy, speech-language therapy, and occupational therapy for as long as your doctor says you need it.
  • Physical therapy: including exercise to regain movement and strength in a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
  • Speech-language therapy (pathology services): including exercise to regain and strengthen speech skills.
  • Occupational therapy: to help you become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities. You may continue to receive occupational therapy even if you no longer need other skilled care if ordered by your doctor.
• medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
• certain medical supplies like wound dressings, but not prescription drugs or biologicals.
• durable medical equipment such as a wheelchair or walker.
• FDA (Food and Drug Administration) approved injectable osteoporosis drugs in certain circumstances.

Medicare doesn’t pay for:

• 24-hour-a-day care at home;
• prescription drugs;
• meals delivered to your home;
• homemaker services like shopping, cleaning, and laundry; and
• personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need. Although Medicare doesn’t cover prescription drugs as part of home health care, a recent law added new prescription drug benefits to the Medicare program as a whole. Under the new law, all people with Medicare will be able to enroll in plans that cover prescription drugs. In 2004, Medicare-approved drug discount cards were made available to help you save on prescription drugs. In 2006, a prescription drug benefit will be added to Medicare that pays some, but not all, of your prescription drug costs.

The Balanced Budget Act of 1997, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) of 1999, called for the development and implementation of a prospective payment system (PPS) for Medicare home health services. The BBA put in place the interim payment system (IPS) until the PPS could be implemented. Effective October 1, 2000, the home health PPS (HH PPS) replaced the IPS for all home health agencies (HHAs). The PPS proposed rule was published on October 28, 1999, with a 60-day public comment period, and the final rule was published on July 3, 2000. How does Prospective Payment System Work? Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country. The adjustment for the health condition, or clinical characteristics, and service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive. While payment for each episode is adjusted to reflect the beneficiary's health condition and needs, a special outlier provision exists to ensure appropriate payment for those beneficiaries that have the most expensive care needs. Adjusting payment to reflect the HHA's cost in caring for each beneficiary including the sickest, should ensure that all beneficiaries have access to home health services for which they are eligible. The home health PPS is composed of six main features:

• Payment for the 60-day EpisodeThe unit of payment under HHA PPS will be for a 60-day episode of care. An agency will receive half of the estimated base payment for the full 60 days as soon as the fiscal intermediary receives the initial claim. This estimate is based upon the patient's condition and care needs (case-mix assignment). The agency will receive the residual half of the payment at the close of the 60-day episode unless there is an applicable adjustment to that amount. The full payment is the sum of the initial and residual percentage payments, unless there is an applicable adjustment. This split percentage payment approach provides reasonable and balanced cash flow for HHAs. Another 60-day episode can be initiated for longer-stay patients.
• Case-mix adjustment -- Adjusting payment for a beneficiary's condition and needsAfter a physician prescribes a home health plan of care, the HHA assesses the patient's condition and likely skilled nursing care, therapy, medical social services and home health aide service needs, at the beginning of the episode of care. The assessment must be done for each subsequent episode of care a patient receives. A nurse or therapist from the HHA uses the Outcome and Assessment Information Set (OASIS) instrument to assess the patient's condition. (All HHAs have been using OASIS since July 19, 1999.) OASIS items describing the patient's condition, as well as the expected therapy needs (physical, speech-language pathology, or occupational) are used to determine the case-mix adjustment to the standard payment rate. This adjustment is the case-mix adjustment. Eighty case-mix groups, or Home Health Resource Groups (HHRG), are available for patient classification. The Home Health Resource Grouping system in the proposed rule uses data from a large-scale case-mix research project conducted between 1997 and 1999.
• Outlier payments - Paying more for the care of the costliest beneficiariesAdditional payments will be made to the 60-day case-mix adjusted episode payments for beneficiaries who incur unusually large costs. These outlier payments will be made for episodes whose imputed cost exceeds a threshold amount for each case-mix group. The amount of the outlier payment will be a proportion of the amount of imputed costs beyond the threshold. Outlier costs will be imputed for each episode by applying standard per-visit amounts to the number of visits by discipline (skilled nursing visits, or physical, speech-language pathology, occupational therapy, or home health aide services) reported on the claims. Total national outlier payments for home health services annually will be no more than 5 percent of estimated total payments under home health PPS.
• Adjustments for beneficiaries who require only a few visits during the 60-day episodeThe proposed home health PPS has a low-utilization payment adjustment for beneficiaries whose episodes consist of four or fewer visits. These episodes will be paid the standardized, service-specific per-visit amount multiplied by the number of visits actually provided during the episode. A savings from reduced episode payments would be redistributed to all episodes paid under the PPS.
• Adjustments for beneficiaries who experience a significant change in their conditionWhen a beneficiary experiences a significant change in condition during the 60-day episode not envisioned in the original physician's plan of care and original case-mix assignment, a Significant Change in Condition (SCIC) Adjustment can occur. A SCIC adjustment requires a new payment amount be determined. The Significant Change in Condition payment adjustment occurs within a given 60-day episode. The total SCIC adjustment is calculated in two parts, which are added together:
  • The first part reflects payment adjustment prior to the significant change in condition:(First billable service date through last billable visit date/60) X original case mix and wage adjusted 60 day episode amount BEFORE significant change in condition).
  • The second part reflects payment adjustment after the significant change in condition for the balance of the episode:(First billable service date through last billable service date/60 X case mix and wage adjusted 60-day episode amount AFTER significant change in condition for the balance of the episode.
• Adjustments for beneficiaries who change HHAs.The home health PPS will include a partial episode payment adjustment. A new episode clock will be triggered when a beneficiary elects to transfer to another HHA or when a beneficiary is discharged and readmitted to the same HHA during the 60-day episode. The partial episode payment (PEP) will provide a simplified approach to the episode definition that takes into account key intervening health events in a patient's care. The partial episode payment allows the 60-day episode clock to end and a new clock to begin if a beneficiary transfers to another HHA or is discharged but returns because of a decline in their condition to the same HHA within the 60-day episode. When a new 60-day episode begins, a new plan of care and a new assessment are necessary. The original 60-day episode payment is proportionally adjusted to reflect the length of time the beneficiary remained under the agency's care before the intervening event. The new episode is paid an initial episode payment of one half of the new case mix group, or HHRG, and the 60-day clock is restarted. Budget neutrality The BBA requires base year PPS outlays to be budget neutral relative to the payments under IPS limits less 15 percent. The Balance Budget Refinement Act of 1999 (BBRA) delayed this reduction in payment limits until one year following the implementation of the PPS. As PPS will begin on October 1, 2000, we will implement this reduction for fiscal year 2002 by reducing what would have been IPS rates, had IPS continued, by 15 percent before calculating the home health PPS rates for fiscal year 2002. Then, the total amounts payable under the PPS will be calculated in a budget neutral fashion relative to the IPS-reduced rates.

Consolidated billing Under the PPS a HHA must bill for all home health services which includes nursing and therapy services, routine and non-routine medical supplies, home health aide and medical social services, except durable medical equipment (DME). DME was excluded from the BBA established consolidated billing requirement by the BBRA. The law requires that all home health services paid on a cost basis be included in the PPS rate. Therefore, the PPS rate will include all nursing and therapy services, routine and non-routine medical supplies, and home health aide and medical social services.

You can only start receiving payments from Medicare for services rendered after you pass an initial survey and certification process conducted by officials from the Texas department of Aging and disability Services (DADS).

Center for Medicare and Medicaid Services (CMS) maintains oversight for compliance with the Medicare health and safety standards for home health agencies (HHAs), The survey (inspection) to determine an applicant’s compliance with all regulatory requirements is done on behalf of CMS by the individual State Survey Agencies or through accreditation by JCAHO, CHAP or ACHC . In this case, the survey is conducted by officials of the Texas department of Aging and Disability Services (DADS) officials or Accreditation body officials. The functions the States or accrediting bodies perform for CMS under the agreements in Section1864 of the Social Security Act (the Act) are referred to collectively as the certification process. When an agency passes this initial survey/certification process, the agency is issued a Medicare provider number. This number is used to identify Home Health Agencies in the Medicare system. This number is also used to bill Medicare for services Home Health Agencies provide.

• An agency must admit at least one client and initiate services within six months of receiving an initial license.
• An agency is not required to admit a client under each category authorized under a license to be surveyed by DADS. An agency seeking licensure to provide licensed home health services or licensed-only hospice services must have admitted and served at least one client in the respective category.
• An agency must submit a written request for an initial survey to the designated survey office at least six months before the expiration date of the initial license, unless an agency is exempt because of accreditation from CHAP or JCAHO after the issuance of the initial license. The written request must include:
  • the date of admission of the first client; and
  • the name of the client.
• An agency must have the following information available and ready for review by a surveyor upon the surveyor's arrival:
  • a list of clients who are receiving services or who have received services from the agency for each category of service licensed.
  • the client records for each client admitted during the licensing period before the initial survey;
  • all agency policies as required by this chapter; and
  • all personnel records of agency employees.
• If an agency fails to meet the requirements of this section, DADS may propose to revoke or suspend an initial license.
• An initial survey is not required if an agency receives notice of accreditation from CHAP or JCAHO after the issuance of the initial license.

• Before beginning a survey, a surveyor holds an entrance conference with the required agency personnel to explain the purpose of the survey and the survey process and provides the personnel an opportunity to ask questions.
  • A surveyor:
    • conducts at least three home visits to determine an agency's compliance with licensing requirements;
    • reviews any agency records that the surveyor believes are necessary to determine an agency's compliance with licensing requirements; and
    • evaluates an agency's compliance with each standard.
  • If a surveyor requests an agency record that is stored at a location other than the survey site, an agency must provide the original record to the surveyor within eight working hours.
• An agency accredited by CHAP or JCAHO must have the documentation of accreditation available at the time of a survey.
• An agency must provide the surveyor access to all agency records maintained by or on behalf of an agency.
• DADS keeps agency records confidential, except as allowed by Texas Health and Safety Code, §142.009(d).
• A surveyor may remove original agency records from an agency only with the consent of the agency as provided in the Texas Health and Safety Code, §142.009(e).
• An agency must provide copies of agency records upon request by the surveyor.

• For an initial survey, the administrator or alternate administrator must be present at the entrance conference, available in person or by telephone during the survey, and present in person at the exit conference.
• For a survey other than an initial survey, the administrator or alternate administrator must be available in person or by telephone during the entrance conference and the survey, and must be present in person at the exit conference.
• The supervising nurse or alternate supervising nurse must be available in person or by telephone, if necessary, to provide information unique to the duties and functions of the position during the survey.
• If a required individual is unavailable during the survey process and is not at the agency when the surveyor arrives, the surveyor makes reasonable attempts to contact the individual.
• If a surveyor arrives during regular business hours and the agency is closed, an administrator, alternate administrator, or a designated agency representative must provide the surveyor entry to the agency within two hours after the surveyor's arrival at the agency. The administrator must designate in writing the agency representatives who may grant entry to a surveyor. The agency must comply with notice requirements described in §97.210 of this chapter (relating to Agency Operating Hours).
• If the surveyor is unable to contact a required individual or the agency fails to comply with subsection (e) of this section, the surveyor may recommend enforcement action against the agency.
• If compliance with this section would cause an interruption in client care being provided by the administrator, the alternate administrator, the supervising nurse, or the alternate supervising nurse, the administrator must contact its backup service provider to ensure continued client care.

This question is asked by a lot of new agency owners. The question is understandable because new owners are eager to recoup the substantial investment of their time and financial resources. However, there is no fixed timeline of how long the process will take. It depends on a lot of factors namely:

• How quickly the agency is able to respond to requests for information from the regulators
• The geographical location of the agency. Naturally, agencies that are located in areas where there is a large number of applications for home health licenses can expect a longer wait that agencies located in areas with a relatively low number of license applications.
• How quickly the agency is able to get to a level of preparedness for the state survey. Well, a lot of new owners are unaware that you are required to notify the DADS office of your readiness to be surveyed. From the time you notify the DADS, it takes anytime from 90 to 180 days typically for the state officials to show up at your agency for survey.

There is no limit to how long a beneficiary may receive home health. Medicare will provide Home Health Agencies with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive

A service area is a list of counties in Texas where a Home Health Agency Provides coverage or services. An agency applying for a license must notify the DADS of it s proposed service area. An agency must not provide services outside its licensed service area. An agency may expand its service area after receiving its license or at any time during licensure by submitting a written notice to DADS at least 30 days prior to the expansion.

The Outcome and Assessment Information Set (OASIS) is a group of data elements that:

• Represent core items of a comprehensive assessment for an adult home care patient; and Form the basis for measuring patient outcomes for purposes of outcome-based quality improvement (OBQI).
• The OASIS is a key component of Medicare’s partnership with the home care industry to foster and monitor improved home health care outcomes.
• HHAs wanting to become Medicare approved must seek guidance and application information from DADS. Before the initial survey is conducted, DADS will communicate with agencies and generally provide information on how agencies can become compliant with the OASIS requirements. Any HHA seeking Medicare certification is required to meet the Medicare Conditions of Participation (COPs) prior to certification. This includes compliance with the OASIS collection and transmission requirements. New HHAs must demonstrate they can transmit OASIS data prior to the initial certification survey. Specifically, new HHAs must apply for temporary user identification numbers and passwords from the state agency OASIS automation coordinator (OAC). This is so the new HHA can electronically transmit to the state OASIS system any encoded and locked start of care or resumption of care OASIS assessment record(s) for applicable Medicare and Medicaid patients in a test mode. New HHAs should work with the OAC in their state to comply with this aspect of the Medicare requirements prior to the initial onsite survey. To meet the OASIS transmission requirements prior to the initial certification survey, new HHAs need two different sets of temporary user identification numbers and passwords; one set to access the Medicare Data Communications Network (MDCN) and one set to access the state OASIS system. The MDCN is how HHAs transmit their OASIS data. New HHAs need to install the communications software, which is separate from the Home Assessment Validation Entry (HAVEN) software, which will allow them to access the MDCN.
• HHAs can call the HAVEN help desk at 1-877-201-4721 for help in obtaining and installing this software. The OAC in each state survey agency should assist the new
• HHA in obtaining the temporary user identification numbers and passwords prior to the initial certification survey. Once the communications software and access are in place, the new HHA must demonstrate that it can transmit OASIS data to the state OASIS system by (1) making a test transmission of any start of care or resumption of care OASIS data that passes CMS edit checks; and 2) receiving validation reports back from the state OASIS system confirming data transmission. The OAC in each state can assist new HHAs with this process. Once Medicare approval has been determined, the OAC assigns a permanent user identification number and password for the new HHA’s access to the state OASIS system. The HHA must apply for permanent user identification numbers and passwords for access to the MDCN by contacting the MDCN help desk at 1-800-905-2069. Alternatives to Direct Transmission to the State OASIS System
• HHAs choosing to use another established HHA (or vendor) to transmit OASIS data on behalf under arrangement with that HHA, must still establish connectivity to the state OASIS system. While the established HHA or vendor will already have the MDCN in place, the appropriate temporary user ids and passwords need to be obtained from the OAC at the state survey agency in order to submit the test transmissions on behalf of the new HHA. Permanent user identification numbers and passwords will be assigned when compliance has been determined, as stated above.
• Determining Compliance with the OASIS Transmission Requirements
• The OAC at the state survey agency can determine the HHAs compliance with the OASIS transmission requirements from their locations; however, the HHA should maintain all copies of validation reports for its own records.
• If the new HHA chooses to use a software vendor to meet the OASIS encoding and/or transmission requirement on its behalf, the HHA must still establish connectivity to the state system via the software vendor. The HHA should have a written contract that describes this arrangement. The HHA or its software vendor must apply for the applicable temporary user identification numbers and passwords from the OAC in order to establish connectivity with the state OASIS system. The HHA should obtain copies of all validation reports from its software vendor for its records.
• If the new HHA chooses to use another certified HHA to meet its transmission requirements, for example, another established HHA in the chain or other established but non-related HHA, the HHA must still demonstrate connectivity to the state system via the other established certified HHA. The new HHA or other HHA must apply for temporary user identification numbers and passwords from the OAC in order to establish connectivity with the state OASIS system. The new HHA must have clearly written policies outlining the procedures in place with the other HHA with regard to OASIS collection, encoding, and submission to the state OASIS system and the sharing of feedback reports from the state OASIS system with the new HHA.
• HHAs Seeking Initial Certification Through an Approved Accreditation Organization (AO)
• An HHA may choose to obtain initial Medicare certification by electing the deemed status option through an approved AO that has been granted deeming authority for Medicare requirements for HHAs. There are currently three AOs with deeming authority; the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Community Health Accreditation Program (CHAP), Accreditation Commission for Health Care. HHAs seeking initial certification through JCAHO, CHAP or ACHC may be required to meet additional accreditation program requirements. However, they still must apply to the state survey agency for user identification numbers and passwords in order to demonstrate compliance with OASIS submission requirements prior to approval.
• Exceptions to Demonstrating Compliance with OASIS Submission Requirements Prior to Approval
• New HHAs that intend to admit or treat only patients to whom OASIS currently does not apply, i.e., patients under 18, maternity, and patients receiving only unskilled care or chore services are not expected to demonstrate compliance with OASIS submission requirements prior to approval. After certification, if there is a change in the HHAs policies that includes the acceptance of patients to whom OASIS applies, the HHA is expected to install the necessary communications software and contact the SA and MDCN for the applicable user identification numbers and passwords.
• Initial Surveys
• AOs will not schedule initial surveys until the state survey agency or AO has determined the HHAs status with the OASIS transmission requirement. HHAs and AOs may contact the state OAC directly to determine the status of the new HHA’s activities concerning the OASIS transmission process prior to scheduling the onsite survey.

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