PURPOSE: This rule defines the minimum requirements for the provision of home health services by state licensed home health programs.

PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

1. (1) State Licensure Requirements.

   1. (A) In all Missouri licensed home health agencies which only provide physical therapy and/or speech therapy and/or occupational therapy and/or medical social work services and which do not have Medicare certification as a provider, the agency shall—

      1. 1. Not be required to provide skilled

nursing services; and

1. 2. Provide the initial evaluation visit be

made by a physician, registered nurse, physical therapist or speech therapist.

1. (B) In all Missouri licensed home health

agencies which only provide physical therapy and/or speech therapy and/or occupational therapy and/or medical social work services and which do not have Medicare certification as a provider, the professional staff shall—

1. 1. Be supervised by a physician, regis-

tered nurse, physical therapist or speech therapist;

1. 2. Include all client medications and

changes in client medications on the plan of care or plan of treatment to be reviewed by the physician; and

1. 3. Include all client diet information and

changes in client diet information on the plan of care or plan of treatment to be reviewed by the physician.

1. (C) Except as specifically provided above, this rule incorporates by reference 42 CFR 484, Medicare Conditions of Participation: Home Health Agencies, for Missouri licensed home health agencies. Missouri licensed home health agencies shall strictly meet the currently applicable Medicare Conditions of

   Rebecca McDowell Cook (12/31/98)*

Participation and surveys performed for state licensure will be conducted per Medicare standards.

1. (2) State Licensure Management.

   1. (A) All licensed home health agencies shall be licensed and shall conduct all their business in their legal name or in their doing business as (d/b/a) name as properly registered with the secretary of state.

   2. (B) Initial Application Procedure for Home Health Agencies.

      1. 1. Upon initial request the Department

of Health (DOH) will determine which type of entity the applicant is requesting application for and mail the appropriate licensure application packet.

1. 2. The applicant shall provide the DOH

with a completed application for home health license, copy of registration with secretary of state and sufficient evidence that the home health agency has established appropriate policies and procedures for providing home health services according to sections 197.400 to 197.477, RSMo. The licensure fee must accompany the application and is nonrefundable. An on-site licensure survey will be conducted prior to issuing a license.

1. A. An out-of-state home health agen-

cy wishing to see Missouri residents must make an application for licensure to the Department of Health (DOH) and establish a branch office in Missouri. The completed application must be submitted with the license fee. A copy of their home health agency license in their home state, a copy (if Medicare certified) of their history with Medicare which can be supplied as a letter or copy of previous certification survey, notification of home state licensure agency of expansion into Missouri and proof of registration with secretary of state in all applicable states. The area served in Missouri by a bordering state agency must be contiguous to the area served by the agency in the bordering state.

1. (C) Annual Renewal Process.

   1. 1. A license shall be renewed annually

upon approval of the department when the following conditions have been met:

1. A. The application for renewal is

accompanied by a six hundred dollar ($600) nonrefundable license fee;

1. B. The home health agency is in com-

pliance with the requirements established under the provisions of sections 197.400 to 197.477, RSMo as evidenced by a survey inspection by the department. In lieu of department survey, such survey as provided in section 197.415.4, RSMo; and

1. C. The application is accompanied by

a statement of any changes in the information 19 CSR 30-26

previously filed with the department under section 497.410, RSMo and the effective date for that change from the information previously filed.

1. D. Proof of registration with secretary

of state’s office in Missouri.

1. 2. The agency shall submit the Applica-

tion for Home Health Agency License and licensure fee prior to the license expiration date. If the license fee is not paid by the expiration date the department may begin the revocation process.

1. (D) Change of Ownership. A license shall not be transferable or assignable.

   1. 1. When a home health agency is sold or

ownership or management is transferred, or the corporate legal organization status is substantially changed, the license of the agency shall be voided and new license obtained.

1. 2. The owner shall apply for a new

license at least ninety (90) calendar days prior to the effective date of sale, transfer, or change in corporate status.

1. 3. The department may issue a tempo-

rary operating permit for the continuation of the operation of the home health agency for a period of not more than ninety (90) days pending the survey inspection and the final disposition of the application.

1. (E) Inspection Process.

   1. 1. The home health agency management

shall allow representatives of the Department of Health (DOH) to survey the home health agency to determine eligibility for licensing and/or renewal of license. On-site surveys may be unannounced.

1. 2. A branch office of an out-of-state

agency shall be subject to an unannounced on-site licensure survey.

1. 3. After completion of each department

survey, a written report of the findings with respect to compliance or noncompliance with the provisions of sections 197.400 to 197.477, RSMo and the standards established thereunder as well as a list of deficiencies found shall be prepared.

1. A. A copy of the deficiency list shall

be sent to the home health agency within fifteen (15) business days following the survey inspection.

1. B. The agency management or

designee shall have ten (10) calendar days following receipt of the written survey report to provide the DOH with a written plan for correcting the cited deficiencies.

1. C. Upon receipt of the required plan

of correction for achieving license compliance, the DOH shall review the plan to determine the appropriateness of the corrective action and respond to the agency. If the plan is not acceptable, the DOH shall notify the management or designee and indicate the reasons why the plan was not acceptable. A revised plan of correction shall be provided to the DOH.

1. D. If an agency does not acknowledge

the deficiencies the agency must, within ten (10) calendar days, request in writing a resurvey by the DOH. If, after the resurvey, the home health agency still does not agree with the findings of the department, it may seek a review of the findings of the department by the Administrative Hearing Commission. A copy of the letter requesting the review must be sent to the DOH.

1. E. Upon expiration of the completion

date for correction of deficiencies specified in the approved plan of correction, the DOH shall determine if the required corrective measures have been acceptably accomplished. The DOH shall document that the corrective action has been satisfactorily completed. If the DOH finds the home health agency still fails to comply with sections of 197.400 to 197.477, RSMo, the DOH may rewrite the deficiencies and request another plan of correction or may take action to suspend or revoke the license.

1. (F) Refusal to Issue/Suspension/Revocation of License. The department shall refuse to issue or shall suspend or shall revoke the license of any home health agency for failure to comply with any provision of sections 197.400 to 197.477, RSMo or with any rule or standard of the department adopted under the provisions of sections 197.400 to 197.477, RSMo or for obtaining the license by means of fraud, misrepresentation, or concealment of material facts.

   1. 1. Any home health agency which has

been refused a license or which has had its license revoked or suspended by the department may seek a review of the department’s action by the Administrative Hearing Commission. A copy of the letter requesting the review must be sent to the DOH.

1. 2. The Department of Health will not

consider application for home health licensure for a period of six (6) months after revocation or denial of the agency’s license.

1. (G) Voluntary Termination.

   1. 1. To voluntarily terminate a home

health agency license, the agency must submit to the DOH, in writing, on agency letterhead the following information:

1. A. A request for termination of their

state license (include license number);

1. B. State the effective date of termina-

tion;

1. C. State disposition of active

caseload; and

1. D. Location of medical record stor-

age.

1. 2. The agency must enclose the original

voided license with the voluntary termination letter.

1. (H) Complaint Procedure. The DOH may accept complaints by phone or in writing.

   1. 1. Any person wishing to make a com-

plaint against a home health agency licensed under the provisions of sections 197.400 to 197.477, RSMo may file the complaint in writing with the department setting forth the details and facts supporting the complaints.

1. 2. The DOH may also accept complaints

regarding a licensed home health agency by phone and may document that the complaint was received.

1. 3. The nature of the complaint will

determine if an investigation is appropriate or if referral of the complaint to another agency is needed.

1. 4. An on-site visit may be made by a

DOH representative and deficiencies may be written.

1. 5. The process for documentation of

complaints will be determined by the DOH.

1. 6. The agency must comply with para-

graph (2)(E)3. in response to deficiencies written as a result of a complaint investigation.

AUTHORITY: section 197.445, RSMo 1997.* Original rule filed Aug. 17, 1998, effective Jan. 30, 1999. *Original authority RSMo 1983, amended 1993, 1995, 1997. (12/31/98)* Rebecca McDowell Cook