10.07.10.13

.13 Program Review and Evaluation.

A. The home health agency shall establish policies and procedures for self-evaluation of its programs. These should include, at a minimum:

(1) Evaluations of staffing patterns to assure adequacy and appropriateness of service delivered;

(2) An annual review of programs to determine:

(a) Trends in service needs and activities;

(b) Problems and unmet needs of patients;

(c) Anticipated changes in delivery of service;

(d) Linkages with related community services.

B. The home health agency shall review its written policies at least annually, and revise them as necessary. The results of this review shall be presented, in writing, to the professional advisory group and to the governing body.

C. Utilization Review.

(1) The home health agency shall establish a program of utilization review which, at a minimum, includes a utilization review committee to review clinical records at least quarterly. The committee members shall represent the scope of services offered by the agency. The clinical record review shall consist of a minimal sampling of 10 percent of unduplicated caseload records per annum or 40 records, whichever is less. All services offered shall be included in the sample.

(2) Sixty Day Continuous Care Review. Each active record shall be reviewed at least every 60 days to determine the adequacy of the plan of treatment and appropriateness of continued service, including renewal of physician orders.

D. The home health agency shall maintain a documented statistical reporting system for each county and the City of Baltimore, if served, which includes, at a minimum:

(1) Number of patients by age, sex, and race receiving each service;

(2) Number of patient visits conducted by each discipline;

(3) Diagnostic categories;

(4) Source of referrals;

(5) Reason for discharge; and

(6) Sources of reimbursement for all services.

E. The home health agency shall:

(1) Prepare a report annually of its documented statistics within 90 days after the close of its fiscal year; and

(2) Beginning with the next fiscal year after adoption of this regulation, submit the report to the Department in the form and manner prescribed by the Secretary with each application for license renewal.