structure and function policy no
Post on 11-Nov-2021
1 Views
Preview:
TRANSCRIPT
HOME HEALTH I Organization’s Name Structure and Function
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION ONE
Structure and Function Policy No.
Scope of Services .............................................................................................................. HH:1-001
Listing of Services Provided ............................................................................................. HH:1-002
Regulatory Compliance .................................................................................................... HH:1-003
Professional Advisory Committee ................................................................................... HH:1-004
Addendum: Professional Advisory Committee Members* ....................................... HH:1-004.A
Home Health Organizational Chart .................................................................................. HH:1-005
Addendum: Organizational Charts* .......................................................................... HH:1-005.A
Home Health Administrator .............................................................................................. HH:1-006
Home Health Clinical Policies and Procedures ................................................................ HH:1-007
Home Health Record Retention ........................................................................................ HH:1-008
Scope of the Behavioral Health Program.......................................................................... HH:1-009
Scope of the Pediatric Program......................................................................................... HH:1-010
Scope of the Obstetrical Program ..................................................................................... HH:1-011
Telemedicine Program ...................................................................................................... HH:1-012
Telemedicine—Patient Privacy ........................................................................................ HH:1-013
Telemedicine—Admission Criteria .................................................................................. HH:1-014
Telemedicine—Plan of Care ............................................................................................. HH:1-015
Telemedicine—Patient Education .................................................................................... HH:1-016
Telemedicine—Discharge Criteria ................................................................................... HH:1-017
Financial Responsibility and Medicare Written Notices .................................................. HH:1-018
Addendum: Advance Beneficiary Notice of Noncoverage (ABN) ........................... HH:1-018.A
Addendum: Home Health Change of Care Notice (HHCCN) .................................. HH:1-018.B
Addendum: Generic Expedited Determination Notice ............................................. HH:1-018.C
Addendum: FFS Expedited Review Detailed Notice ................................................ HH:1-018.D
Addendum: Additional CMS Resources for Expedited Notices ............................... HH:1-018.E
Corporate Compliance Plan* ............................................................................................ HH:1-019
Addendum: Sample Compliance Report ................................................................... HH:1-019.A
SAMPLE
HOME HEALTH I Organization’s Name Structure and Function
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION ONE
Structure and Function Policy No.
Corporate Compliance Officer .......................................................................................... HH:1-020
Internal Control Systems/Accountabilities ....................................................................... HH:1-021
Whistleblower Protection.................................................................................................. HH:1-022
SAMPLE
HOME HEALTH II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products
Admission to Home Health Policy No.
Home Health Patient Bill of Rights .................................................................................. HH:2-001
Intake Process ................................................................................................................... HH:2-002
Admission Criteria and Process ........................................................................................ HH:2-003
Addendum: Face-to-Face Encounter Procedure * ...................................................... HH:2-003.A
Care Planning
Care Planning Process....................................................................................................... HH:2-004
Physician Participation in Plan of Care ............................................................................ HH:2-005
Verification of Physician Orders ...................................................................................... HH:2-006
Rehabilitation Care Planning ............................................................................................ HH:2-007
Nutrition Care Planning .................................................................................................... HH:2-008
Home Health Aide Plan of Care ....................................................................................... HH:2-009
Orientation of Assigned Home Health Aide ..................................................................... HH:2-010
Support/Chore Worker Service Plan ................................................................................. HH:2-011
Discharge Planning ........................................................................................................... HH:2-012
Coordination/Continuity of Care
Continuity of Care............................................................................................................. HH:2-013
Case Conference/Progress Summary ................................................................................ HH:2-014
Monitoring Patient’s Response/Reporting to Physician ................................................... HH:2-015
60-Day Summary Report ................................................................................................. HH:2-016
Patient Notification of Changes in Care ........................................................................... HH:2-017
On-Call/Weekend Staffing................................................................................................ HH:2-018
Coordination of Services With Other Providers .............................................................. HH:2-019
Internal Referral Process ................................................................................................... HH:2-020
SAMPLE
HOME HEALTH II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products
Assessment Policy No.
Initial and Comprehensive Assessment ............................................................................ HH:2-021
Ongoing Assessments ....................................................................................................... HH:2-022
Reassessments/Recertification .......................................................................................... HH:2-023
Functional Assessment...................................................................................................... HH:2-024
Nutritional Assessment ..................................................................................................... HH:2-025
Pain Assessment................................................................................................................ HH:2-026
Assessment of Possible Abuse/Neglect ............................................................................ HH:2-027
Addendum: Organization List of Private & Public Community Agencies That
Provide or Arrange for Assessment of Suspected or Alleged
Abuse/Neglect Victims* ........................................................................ HH:2-027.A
Medication Administration
Medication Profile ............................................................................................................ HH:2-028
Identification of Medication for Administration............................................................... HH:2-029
Administration and Documentation of Medications ......................................................... HH:2-030
Addendum: Drug/Classifications and Their Routes ................................................. HH:2-030.A
Addendum: Medications Not Approved for Safe Home Administration* ................ HH:2-030.B
Addendum: Drug Information for the Nurse* ........................................................... HH:2-030.C
Addendum: Advice for the Patient—Drug Information in Lay Language* ............. HH:2-030.D
Patient Self-Administration of Medication ....................................................................... HH:2-031
Home Use and Disposal of Controlled Substances........................................................... HH:2-032
Intravenous Administration of Medications/Solutions ..................................................... HH:2-033
Addendum: Medications Approved/Not Approved for Intravenous Administration HH:2-033.A
Intravenous Administration of Chemotherapy.................................................................. HH:2-034
Addendum: Antineoplastic Medications Approved/Not Approved for Intravenous
Administration* ..................................................................................... HH:2-034.A
First Dose Policy ............................................................................................................... HH:2-035
SAMPLE
HOME HEALTH II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products
Medication Administration (continued) Policy No.
Crushing of Medications ................................................................................................... HH:2-036
Addendum: Oral Dosage Forms That Should Not Be Crushed* ............................... HH:2-036.A
Pulse Rate Determination With Certain Drugs ................................................................. HH:2-037
Storage of Medications and Nutritional Products ............................................................. HH:2-038
Medication Labeling ......................................................................................................... HH:2-039
Adverse Drug Reactions ................................................................................................... HH:2-040
Addendum: Advice About Voluntary Reporting ....................................................... HH:2-040.A
Anaphylaxis Protocol ........................................................................................................ HH:2-041
Medication Error .............................................................................................................. HH:2-042
Medication Monitoring ..................................................................................................... HH:2-043
Investigational Medications .............................................................................................. HH:2-044
Clinical Care
Waived Testing ................................................................................................................. HH:2-045
Addendum: Organization List and Criteria for Waived Tests Performed* ............... HH:2-045.A
Home Glucose Monitoring ............................................................................................... HH:2-046
Do Not Resuscitate/Do Not Intubate Orders .................................................................... HH:2-047
Cardiopulmonary Resuscitation ........................................................................................ HH:2-048
Withdrawal of Life-Sustaining Care ................................................................................. HH:2-049
Care of the Dying Patient .................................................................................................. HH:2-050
Transfer and Discharge
Transfer/Referral Criteria and Process .............................................................................. HH:2-051
Transfer Summary ............................................................................................................ HH:2-052
Discharge Criteria and Process ......................................................................................... HH:2-053
Discharge Summary .......................................................................................................... HH:2-054
SAMPLE
HOME HEALTH II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products
Clinical Record, Documentation, and Data Collection Policy No.
Contents of Clinical Record .............................................................................................. HH:2-055
Assembly of Clinical Record ............................................................................................ HH:2-056
Clinical Record Review .................................................................................................... HH:2-057
External Databases ............................................................................................................ HH:2-058
OASIS Reporting
OASIS Data Transmission ................................................................................................ HH:2-059
Experience of Care
Patient and Family/Caregiver Experience of Care Survey ............................................... HH:2-060
Addendum: Patient and Family/Caregiver Experience of Care Survey for Exempt
or Non-Participating Home Health Agency .............................................................. HH:2-060.A
Other
Missed Visits ..................................................................................................................... HH:2-061
SAMPLE
HOME HEALTH III Organization’s Name Human, Financial, and Physical Resources
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION THREE
Human, Financial, and Physical Resources
Policy No.
Home Health Human Resources ....................................................................................... HH:3-001
Home Health Staffing Guidelines ..................................................................................... HH:3-002
Responsibilities/Supervision of Clinical Services ............................................................ HH:3-003
Supervision ....................................................................................................................... HH:3-004
Access to Qualified Consultation...................................................................................... HH:3-005
Consultation for Specialty Services .................................................................................. HH:3-006
Communication With Office............................................................................................. HH:3-007
Home Health Contracted Services .................................................................................... HH:3-008
Addendum: Home Health Contracted Services Review* .......................................... HH:3-008.A
Contracted Service Providers ............................................................................................ HH:3-009
Training/Inservice Education ............................................................................................ HH:3-010
Competency Assessment .................................................................................................. HH:3-011
Home Health Aide Training.............................................................................................. HH:3-012
Home Health Aide Supervisory Visits .............................................................................. HH:3-013
Physician Licensure Verification ...................................................................................... HH:3-014
Home Health Capital Expenditure Plan ............................................................................ HH:3-015
Note:
Job Descriptions can be found in Section 6 of this manual.
Clinical Competency Assessment Skills Checklists can be found as Appendices at the end of
Section 6 of this manual.
SAMPLE
HOME HEALTH IV Organization’s Name Long Term Viability
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION FOUR
Long Term Viability
Policy No.
Home Health Annual Evaluation ...................................................................................... HH:4-001
Home Health Innovation ................................................................................................... HH:4-002
SAMPLE
HOME HEALTH V Organization’s Name Patient and Family/Caregiver Education
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION FIVE
Patient and Family/Caregiver Education
Policy No.
Patient Education Process ................................................................................................. HH:5-001
Safe/Effective Use of Medications ................................................................................... HH:5-002
Drug–Food Interactions .................................................................................................... HH:5-003
Pain Management Education ............................................................................................ HH:5-004
Rehabilitation Techniques ................................................................................................ HH:5-005
Appropriate Use of Restraints and Supplies ..................................................................... HH:5-006
Safe/Effective Use of Equipment and Supplies ................................................................ HH:5-007
Storage, Handling, and Access to Supplies and Gases ..................................................... HH:5-008
Identification, Handling, and Disposal of Hazardous Waste ............................................ HH:5-009
Infection Control Precautions ........................................................................................... HH:5-010
Natural Disasters/Emergencies ......................................................................................... HH:5-011
Addendum: Guidelines for Emergency Management* ............................................. HH:5-011.A
Basic Home Safety ............................................................................................................ HH:5-012
Addendum: Fall Reduction Program* ....................................................................... HH:5-012.A
Patient Education Related to Discharge Planning ............................................................ HH:5-013
Educational Resources ...................................................................................................... HH:5-014
Community Resources ...................................................................................................... HH:5-015
SAMPLE
HOME HEALTH VI Organization’s Name Job Descriptions
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION SIX
Job Descriptions Policy No.
Policy Statement ...................................................................................................................... 6-001
Addendum: Job Description (Template) .......................................................................... 6-001.A
Addendum: Physical Requirements .................................................................................. 6-001.B
Professional Services Agreement For Medical Director ......................................................... 6-002
Addendum: Professional Services Agreement For Medical Director (Sample) ............... 6-002.A
JOB TITLES/POSITIONS
Executive Director/Administrator
Finance Director
Controller
Human Resources Director
Information Systems Director
Marketing/Community Relations Director
Clinical Director/Director of Patient Care Services
Clinical Records Manager
Clinical Supervisor/Nursing Supervisor
Managed Care Coordinator
Referral/Intake Supervisor
Performance Improvement Coordinator
Home Care Coordinator
Home Health Nurse Practitioner
Infusion Therapy Nurse Coordinator
OASIS Review Nurse
Registered Nurse
Addendum A: Performance Evaluation for the Registered Nurse (Template)
Licensed Practical/Vocational Nurse
Addendum A: Performance Evaluation for the Licensed Practical Nurse (Template)
SAMPLE
HOME HEALTH VI Organization’s Name Job Descriptions
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION SIX
Job Descriptions
Job Titles/Positions (Continued)
Certified Home Health Aide
Addendum A: Performance Evaluation for the Certified Home Health Aide (Template)
Addendum B: Home Health Aide Training Agreement (Sample)
Nurse Assistant
Rehabilitation Supervisor
Physical Therapist
Physical Therapy Assistant
Speech–Language Pathologist
Occupational Therapist
Certified Occupational Therapy Assistant
Social Services Supervisor
Medical Social Worker
Registered Dietician
Secretary/Receptionist
Billing Manager
Accounting Clerk
Data Entry/Computer Operator
Billing/Collections Clerk
Filing/Data Processing Clerk
Office Manager
Payroll and Benefits Coordinator
Scope of the Program/Process Methodology .................................................................... HH:6-003
Competency Based Orientation ........................................................................................ HH:6-004
Addendum: Initial Competency Assessment Skills Checklist/RN ............................ HH:6-004.A
Addendum: Initial Competency Assessment Skills Checklist/LPN/VN ................... HH:6-004.B
Addendum: Initial Competency Assessment Skills Checklist/Infusion Nurse .......... HH:6-004.C
Addendum: Initial Competency Assessment Skills Checklist/HHA ......................... HH:6-004.D
SAMPLE
HOME HEALTH VI Organization’s Name Job Descriptions
*Requires organization-specific information.
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
SECTION SIX
Job Descriptions
Addendum: Initial Competency Assessment Skills Checklist/PT ............................. HH:6-004.E
Addendum: Initial Competency Assessment Skills Checklist/PTA ........................... HH:6-004.F
Addendum: Initial Competency Assessment Skills Checklist/Speech/Language ..... HH:6-004.G
Addendum: Initial Competency Assessment Skills Checklist/OT ............................ HH:6-004.H
Addendum: Initial Competency Assessment Skills Checklist/OTA ........................... HH:6-004.I
Addendum: Initial Competency Assessment Skills Checklist/MSW ......................... HH:6-004.J
Addendum: Initial Competency Assessment Skills Checklist/Reg. Dietician .......... HH:6-004.K
Core Competency Skills ................................................................................................... HH:6-005
Annual Core Competence ................................................................................................. HH:6-006
Addendum: Performance Criteria (Template) ........................................................... HH:6-006.A
Addendum: Performance Criteria (Sample) .............................................................. HH:6-006.B
Addendum: Performance Criteria (Sample for the Infusion Nurse) .......................... HH:6-006.C
Specialized Services.......................................................................................................... HH:6-007
Requirements for Supervisors/Preceptors ......................................................................... HH:6-008
Addendum: Performance Observation Report ........................................................... HH:6-008.A
Report to the Governing Body .......................................................................................... HH:6-009
Addendum: Organization Competence Report .......................................................... HH:6-009.A
SAMPLE
Organization’s Name ATTACHMENTS
California CHAP Home Health Manual/Revised October 2015 © 2003 The Corridor Group
ATTACHMENTS
Attachment I: ........................................................................................................ CHAP Crosswalk
Attachment II: ........................................................................ Medicare Conditions of Participation
Attachment III: .......................................................... Home Health Agency Interpretive Guidelines
Attachment IV:.................................................................................. Home Health Agency Manual
Attachment V .................................................................................................. Additional Resources
SAMPLE
CORE I Organization’s Name Structure and Function
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION ONE
Structure and Function Policy No.
Mission Statement ................................................................................................................ C:1-001
Governing Body ................................................................................................................... C:1-002
Addendum: Governing Body Members*...................................................................... C:1-002.A
Addendum: Governing Body Orientation Checklist* .................................................. C:1-002.B
Conflict of Interest ............................................................................................................... C:1-003
Referral Disclosure and Care Decisions .............................................................................. C:1-004
Administrative Qualifications and Responsibilities............................................................. C:1-005
Appointment of Executive Director/Administrator ............................................................. C:1-006
Designation of Individual in Absence of Executive Director/Administrator ...................... C:1-007
Use of Organizational Chart ................................................................................................ C:1-008
Addendum: Organizational Charts* ............................................................................. C:1-008.A
Policy Decisions................................................................................................................... C:1-009
Development of Policies and Procedures ............................................................................ C:1-010
Addendum: Required Policy Checklist ........................................................................ C:1-010.A
Addendum: Administrative Policy Renewal/Revision Flow Sheet .............................. C:1-010.B
Facilitating Communication*............................................................................................... C:1-011
Addendum: Organization List of Interpreters* ............................................................. C:1-011.A
Ethical Issues ....................................................................................................................... C:1-012
Nondiscrimination Policy and Grievance Process* ............................................................. C:1-013
Uniform Quality of Care ...................................................................................................... C:1-014
Experimental Research and Investigational Studies ............................................................ C:1-015
Record Retention ................................................................................................................. C:1-016 SAMPLE
CORE II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products Policy No.
Public Disclosure Statement ................................................................................................ C:2-001
Admission Documents ......................................................................................................... C:2-002
Patient Bill of Rights ............................................................................................................ C:2-003
Informed Consent/Refusal of Treatment ............................................................................. C:2-004
Addendum: Sample Informed Consent for Medical Photography ....................................C:2-004.A
Financial Responsibility....................................................................................................... C:2-005
Advance Directives .............................................................................................................. C:2-006
Addendum: Advance Directive Information Statement ............................................... C:2-006.A
Addendum: Durable Power of Attorney for Health Care* ........................................... C:2-006.B
Addendum: POLST Policy* ......................................................................................... C:2-006.C
Complaint/Grievance Process .............................................................................................. C:2-007
Care/Service Coordination ................................................................................................... C:2-008
Availability of Services........................................................................................................ C:2-009
Emergency Management Plan ............................................................................................. C:2-010
Addendum: Pyramid Phone Communication Plan* ..................................................... C:2-010.A
Addendum: Weather Report/Road Conditions* ........................................................... C:2-010.B
Fostering Internal Communication ...................................................................................... C:2-011
Interface of Patient Data and Management Systems ........................................................... C:2-012
Access to Information .......................................................................................................... C:2-013
Principles of Information Management ............................................................................... C:2-014
Patient Privacy Rights .......................................................................................................... C:2-015
Addendum: Notice of Privacy Practices ....................................................................... C:2-015.A
Minimum Necessary Uses of PHI........................................................................................ C:2-016
Minimum Necessary Disclosures of PHI ............................................................................. C:2-017
Uses and Disclosures of PHI................................................................................................ C:2-018
Authorization for Use or Disclosure of PHI ........................................................................ C:2-019
Minimum Necessary Requests For PHI ............................................................................... C:2-020
Privacy of Health Information of Deceased Individuals ...................................................... C:2-021
SAMPLE
CORE II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products Policy No.
Patient Requests for Privacy Restrictions ............................................................................ C:2-022
Patient Requests for Confidential Communications ............................................................ C:2-023
Patient Requests for Access to PHI ..................................................................................... C:2-024
Patient Requests to Amend PHI ........................................................................................... C:2-025
Patient Requests for Accounting of PHI Disclosures .......................................................... C:2-026
Fundraising and PHI ............................................................................................................ C:2-027
Marketing and PHI ............................................................................................................... C:2-028
Privacy Training................................................................................................................... C:2-029
Sanctions for Privacy and Security Violations .................................................................... C:2-030
Safeguarding/Retrieval of Clinical/Service Record ............................................................. C:2-031
Computer Access to Information ......................................................................................... C:2-032
Clinical/Service Data Collection.......................................................................................... C:2-033
Retention of Clinical/Service Records ................................................................................. C:2-034
Branch/Subunit Documentation Control.............................................................................. C:2-035
Abbreviations and Symbols ................................................................................................. C:2-036
Addendum: Approved Home Care/Service Abbreviations* ........................................ C:2-036.A
Addendum: Unacceptable Home Care/Service Abbreviations* ................................... C:2-036.B
Responsibilities in Improving Performance......................................................................... C:2-037
Patient Focused Performance Improvement ........................................................................ C:2-038
Patient and Family/Caregiver Experience of Care Survey .................................................. C:2-039
Infection Control Plan .......................................................................................................... C:2-040
Tuberculosis Exposure Control Plan ................................................................................... C:2-041
Bloodborne Pathogens and Hepatitis B Exposure Control Plan .......................................... C:2-042
Addendum: Hepatitis B Vaccination Documentation Form ......................................... C:2-042.A
SAMPLE
CORE II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products Policy No.
Addendum: Hepatitis B Vaccination Declination Form ............................................... C:2-042.B
Addendum: Recognizing the Dangers ........................................................................... C:2.042.C
Addendum: Occupational Exposure Risk By Job Classification ................................. C:2-042.D
Management of Exposures in Personnel .............................................................................. C:2-043
Record Keeping ................................................................................................................... C:2-044
Occupational Exposure Information and Training .............................................................. C:2-045
Standard Precautions ............................................................................................................ C:2-046
Addendum: Standard Precautions Information for Personnel ...................................... C:2-046.A
Personal Protective Equipment ............................................................................................ C:2-047
Addendum: Protective Device Checklist ...................................................................... C:2-047.A
Addendum: Required Personal Protective Equipment Form ........................................ C:2-047.B
Hand Hygiene ...................................................................................................................... C:2-048
Clean vs. Aseptic Technique ................................................................................................ C:2-049
Infection Control/Expanded Precautions ............................................................................. C:2-050
Addendum: Bed Bug Guidance* ................................................................................ C:2-050.A
Contaminated Materials Disposition.................................................................................... C:2-051
Contaminated Waste Disposal ............................................................................................. C:2-052
Hazardous Waste Handling.................................................................................................. C:2-053
Addendum: Hazardous Waste Disposal State and Local Regulations* ....................... C:2-053.A
Accidental Exposure to Blood ............................................................................................. C:2-054
Bag Technique ..................................................................................................................... C:2-055
Evaluating and Maintaining Records of Infections Among Patients ................................... C:2-056
Addendum: Infection Identification—Patient Report .................................................. C:2-056.A
Evaluating and Maintaining Records of Infections Among Personnel ................................ C:2-057
Addendum: Infection Identification—Personnel Report .............................................. C:2-057.A
Reporting of Communicable Diseases ................................................................................. C:2-058
Communication of Hazards to Personnel ............................................................................ C:2-059
SAMPLE
CORE II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products Policy No.
Environmental Safety Program ............................................................................................ C:2-060
Environmental Safety—Office ............................................................................................ C:2-061
Addendum: Office Environment Checklist .................................................................. C:2-061.A
Fire Safety—Office .............................................................................................................. C:2-062
Utilities Management—Office ............................................................................................. C:2-063
Equipment Management—Office ........................................................................................ C:2-064
Environmental Safety—Patient ........................................................................................... C:2-065
Fire Safety—Patient ............................................................................................................. C:2-066
Utilities Management—Patient ............................................................................................ C:2-067
Equipment Management—Patient ....................................................................................... C:2-068
Safe and Appropriate Use of Home Medical Equipment and Supplies ............................... C:2-069
Storage of Medications and Nutritional Therapies .............................................................. C:2-070
Medical Equipment Malfunction ......................................................................................... C:2-071
Safe Medical Device Act ..................................................................................................... C:2-072
Organization Personnel Safety—Personal Safety ................................................................ C:2-073
Organization Personnel Safety—Unsafe Home Visits ........................................................ C:2-074
Vehicle Accident Reporting ................................................................................................. C:2-075
Incident Reporting ............................................................................................................... C:2-076
Addendum: Examples of Specific Events or Occurrences
That Must Be Reported ............................................................................ C:2-076.A
Serious Adverse Events ....................................................................................................... C:2-077
Root Cause Analysis/Action Plan ........................................................................................ C:2-078
Addendum: Root Cause Analysis/Action Plan Form ................................................... C:2-078.A
Aggregation of Data/Information ........................................................................................ C:2-079
Identity Theft Prevention Program ...................................................................................... C:2-080
Addendum: Identity Theft Risk Assessment Worksheet .............................................. C:2-080.A
SAMPLE
CORE II Organization’s Name Quality of Services and Products
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION TWO
Quality of Services and Products Policy No.
Addendum: Identity Theft Risk Response Matrix ........................................................ C:2-080.B
Pandemic Influenza Preparedness ........................................................................................ C:2-081
Addendum: Reference for Pandemic Influenza Preparedness ...................................... C:2-081.A
Security of PHI .................................................................................................................... C:2-082
Breach Analysis ................................................................................................................... C:2-083
Breach Notification .............................................................................................................. C:2-084
Security Management Process ............................................................................................. C:2-085
Workforce Security .............................................................................................................. C:2-086
Information Access Management ........................................................................................ C:2-087
Security Awareness and Training ........................................................................................ C:2-088
Security Incident Procedures ............................................................................................... C:2-089
Contingency Plan ................................................................................................................. C:2-090
Evaluation ............................................................................................................................ C:2-091
Facility Access Controls ...................................................................................................... C:2-092
Workstation Use and Security ............................................................................................. C:2-093
Device and Media Controls ................................................................................................. C:2-094
Access Controls: Technical Safeguards ............................................................................... C:2-095
HIPAA Security Audit Controls .......................................................................................... C:2-096
Integrity Controls ................................................................................................................. C:2-097
Person or Entity Authentication ........................................................................................... C:2-098
Transmission Security .......................................................................................................... C:2-099
SAMPLE
CORE III Organization’s Name Human, Financial, and Physical Resources
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION THREE
Human, Financial, and Physical Resources Policy No.
Personnel Policies ................................................................................................................ C:3-001
Recruitment, Retention, Development, and Continuing Education ..................................... C:3-002
Categories/Qualifications of Personnel................................................................................ C:3-003
Selection/Hiring of Personnel .............................................................................................. C:3-004
Licensure/Certification/Registration .................................................................................... C:3-005
Equal Opportunity Employer ............................................................................................... C:3-006
Standards of Care, Service, and Practice ............................................................................. C:3-007
Scope of Assessments/Qualifications .................................................................................. C:3-008
Job Descriptions ................................................................................................................... C:3-009
Termination .......................................................................................................................... C:3-010
Personnel Turnover .............................................................................................................. C:3-011
Attendance and Absenteeism ............................................................................................... C:3-012
Personnel Grievance Process ............................................................................................... C:3-013
Personal Vehicle Use/Mileage Requirements ...................................................................... C:3-014
Dress and Appearance.......................................................................................................... C:3-015
Sexual Harassment ............................................................................................................... C:3-016
Standards of Conduct/Ethical Behavior ............................................................................... C:3-017
Personnel Record Contents .................................................................................................. C:3-018
Performance Evaluations ..................................................................................................... C:3-019
Orientation ........................................................................................................................... C:3-020
Addendum: Personnel Orientation Checklist ............................................................... C:3-020.A
Personnel Development ....................................................................................................... C:3-021
Addendum: Personnel Development/Inservice Needs Assessment ............................. C:3-021.A
Resource Information........................................................................................................... C:3-022
Competency Program........................................................................................................... C:3-023
Initial Competency Assessment ........................................................................................... C:3-024
SAMPLE
CORE III Organization’s Name Human, Financial, and Physical Resources
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION THREE
Human, Financial, and Physical Resources Policy No.
Competency Requirements for Supervisors/Preceptors ....................................................... C:3-025
Addendum: Performance Observation Report .............................................................. C:3-025.A
Competency Report to the Governing Body ........................................................................ C:3-026
Addendum: Organization Competency Report ............................................................ C:3-026.A
Written Agreements for Contracted Services ...................................................................... C:3-027
Addendum: Written Agreement for Home Care Services* .......................................... C:3-027.A
Business Associates ............................................................................................................. C:3-028
Annual Operating Budget .................................................................................................... C:3-029
Certificates of Insurance ...................................................................................................... C:3-030
Financial Management and Control ..................................................................................... C:3-031
Fiscal Solvency .................................................................................................................... C:3-032
Financial Reports ................................................................................................................. C:3-033
Fee Determination ................................................................................................................ C:3-034
Charity Care ......................................................................................................................... C:3-035
Charge Verification .............................................................................................................. C:3-036
Billing and Collections ........................................................................................................ C:3-037
Accounts Receivable Review .............................................................................................. C:3-038
Bad Debt Policy ................................................................................................................... C:3-039
Contractual Allowances ....................................................................................................... C:3-040
Cash Receipts ....................................................................................................................... C:3-041
Purchasing Authorization and Accounts Payable ................................................................ C:3-042
Fixed Assets and Depreciation............................................................................................. C:3-043
Payroll Processing ................................................................................................................ C:3-044
Allocation of Time Worked ................................................................................................. C:3-045
SAMPLE
CORE III Organization’s Name Human, Financial, and Physical Resources
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION THREE
Human, Financial, and Physical Resources Policy No.
Social Media ........................................................................................................................ C:3-046
Addendum: Social Media and Blog Guidelines ........................................................... C:3-046.A
Progressive Discipline Policy .............................................................................................. C:3-047
SAMPLE
CORE IV Organization’s Name Long Term Viability
*Requires organization-specific information.
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
SECTION FOUR
Long Term Viability Policy No.
Organizational Planning....................................................................................................... C:4-001
Program Planning................................................................................................................. C:4-002
Marketing Plan ..................................................................................................................... C:4-003
Contingency Planning .......................................................................................................... C:4-004
Contingency Plan if Organization Closes ............................................................................ C:4-005
Measuring Performance of the Environmental Safety Program .......................................... C:4-006
Annual Organization Evaluation.......................................................................................... C:4-007
Addendum: Self-Assessment of Health Care
Organizational Performance ..................................................................... C:4-007.A
SAMPLE
CORE MANUAL Organization’s Name Attachments
California CHAP Core Manual/Revised October 2015 © 2003 The Corridor Group
ATTACHMENTS
Attachment I: ........................................................................................................ CHAP Crosswalk
Attachment II: ...................................................................................................... Glossary of Terms
SAMPLE
top related