Compliance & Care Standards

NH RSA 151:21-b Home Care Clients’ Bill of Right

I. Home health care providers shall provide each client or client’s legal representative with a written copy of the rights and responsibilities listed in paragraphs II and III of this section in advance of or during the initial evaluation visit and before initiation of care. These rights apply only to the services delivered by or on behalf of the home health care provider. If a client cannot read the statement of rights it shall be read to the client in a language such client understands. For a minor or a client needing assistance in understanding these rights, both the client and the client’s legal representative shall be fully informed of these rights.

II. The statement of rights shall state that at a minimum the client has a right to:

(a) Be treated with consideration, respect, and full recognition of the client’s dignity and individuality, including privacy in treatment and personal care and respect for personal property and including being informed of the name, licensure status, and staff position and employer of all persons with whom the client/resident has contact, pursuant to RSA 151:3-b.

(b) Receive appropriate and professional care without discrimination based on race, color, national origin, religion, sex, disability, or age, nor shall any such care be denied on account of the patient’s sexual orientation.

(c) Participate in the development and periodic revision of the plan of care, and to be informed in advance of any changes to the plan or intent to discharge except as provided in RSA 151:26-a, III.

(d) Be informed that care is evaluated through the provider’s quality assurance program.

(e) Refuse treatment within the confines of the law and to be informed of the consequences of such action, and to be involved in experimental research only upon the client’s voluntary written consent.

(f) Voice grievances and suggest changes in service or staff without fear of restraint, discrimination, or reprisal.

(g) Be free from emotional, psychological, sexual, and physical abuse and from exploitation by the home health care provider.

(h) Be free from chemical and physical restraints except as authorized in writing by a physician.

(i) Be ensured of confidential treatment of all information contained in the client’s personal and clinical record, including the requirement of the client’s written consent to release such information to anyone not otherwise authorized by law to receive it. Medical information contained in the client’s record shall be deemed to be the client’s property and the client has the right to a copy of such records upon request and at a reasonable cost.

(j) Be informed in advance of the charges for services, including payment for care expected from third parties and any charges the client will be expected to pay.

III. The provider has the right to expect the client or the client’s legal representative will:

(a) Give accurate and complete health information.

(b) Create and maintain an environment that is safe and free from sexual or other forms of harassment by the client or others in the home. For the purpose of this subparagraph, an environment is unsafe if conditions in and around the home imminently threaten the safety of the home health care provider personnel or jeopardize the home health care provider’s ability to provide care.

(c) Participate in developing and following the plan of care.

(d) Request information about anything that is not understood, and express concerns regarding services provided.

(e) Inform the provider when unable to keep an appointment for a home care visit.

(f) Inform the provider of the existence of, and any changes made to, advance directives.

All complaints regarding “Patients’ Rights” contained in State of New Hampshire RSA Section 151:21-b should be directed to the Quality Manager or the President/CEO of HHHC by calling 603-882-2941 between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday.

Privacy Policy

Protecting your confidential health information is extremely important to Home Health & Hospice Care. This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully. 

Notice of Privacy Practices

The privacy practices described in this notice apply to Home Health & Hospice Care (“Company”).  The Company is required by the federal law known as the Health Insurance Portability and Accountability Act (referred to as the HIPAA Privacy Rule) to take reasonable steps to ensure the privacy of your personally identifiable health information (Protected Health Information) and to inform you about:

• the Company’s uses and disclosures of Protected Health Information;
• your privacy rights with respect to your Protected Health Information;
• your right to file a complaint with the Company and to the Secretary of the U.S. Department of Health and Human Services; and
• the person or office to contact for further information about the Company’s privacy practices.

Uses and Disclosures of Protected Health Information
Except as otherwise provided in this notice or otherwise permitted under the HIPAA Privacy Rule, uses and disclosures of Protected Health Information will be made only with your written authorization subject to your right to revoke such authorization. If you provide the Company authorization to use or disclose PHI about you, you may revoke that permission, in writing, at any time by sending a notice of revocation to the Privacy Officer at the address provided below.  If you revoke your permission, the Company will no longer use or disclose PHI about you for the reasons covered by your written authorization.  The Company will not be able to reverse any disclosures made prior to your revocation.

The Company may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Note: Special rules may apply with respect to the use and disclosure of genetic and HIV testing information.  You may contact the Privacy Officer for more information about these rules.

Uses and Disclosures that Require Your Written Authorization
Your written authorization is generally required before the Company will use or disclose psychotherapy notes about you from your psychotherapist. Psychotherapy notes are separately filed notes about your conversations with your mental health professional during a counseling session.  They do not include summary information about your mental health treatment.  The Company may use and disclose such notes when needed by the Company to defend against litigation filed by you.

To the extent the Company uses and discloses your Protected Health Information for certain marketing purposes, it will obtain your specific authorization to the extent required by law. Additionally, any disclosures that constitute the sale of your Protected Health Information will also require your specific authorization unless otherwise permitted or required by law.

Uses and Disclosures to Carry Out Treatment, Payment and Health Care Operations
The HIPAA Privacy Rule permits the Company and its respective Business Associates to use and disclose Protected Health Information without your consent, authorization, or opportunity to agree or object, to carry out Treatment, Payment and Health Care Operations.

• Treatment is the provision, coordination or management of health care and related services. For example, the Company may disclose your Protected Health Information to your primary care provider to assist in the coordination of your care.
• Payment includes but is not limited to actions to make coverage determinations and payment (including Medicare/insurance eligibility and coverage, and billing). For example, the Company may submit its charges for payment to your insurance carrier or Medicare for payment.
• Health Care Operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, and working with vendors to coordinate your care. For example, the Company may share your medical records with peer review committees to assess and improve the level of care you are receiving.
• Fundraising Activities. The Agency may place your name, email, and address on its mailing list to send you a copy of the agency’s e-newsletter, semi-annual newsletter and information about HHHC’s development activities. In addition, the Agency may use your name, email, address, and phone number to contact you for the consent to use information about you and the services you received (e.g., nursing, homemaking, physical therapy) for the fundraising purposes of Home Health & Hospice care. If you do not want the agency to contact you by phone or send any literature via the mail, please notify the Development Department at 603-882-2941 and indicate that you do not wish to be contacted.
• Annual Memorial Service. Several times a year, HHHC holds a memorial service to remember those patients who we have served and have died during the past year. Surviving loved ones are invited, and patient names are printed in the program and read aloud during the service. If you do not wish to have your name included in this service, please notify the Bereavement Coordinator at 603-882-2941 and indicate that you wish to have your name omitted.
• Appointment Reminders. The Agency may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

Uses and Disclosures that Require that You be given an Opportunity to Agree or Disagree Prior to the Use or Release
Disclosure of your Protected Health Information to family members, other relatives and your close personal friends is allowed if:

• the information is directly relevant to the family or friend’s involvement with your care or payment for that care; and
• you have either agreed to the disclosure or have been given an opportunity to object and have not objected.

Other Uses and Disclosures for which Consent, Authorization or Opportunity to Object is not Required
Use and disclosure of your Protected Health Information is allowed without your consent, authorization or request under the following circumstances:

• When required by law.
• When permitted for purposes of public health activities, including if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if authorized by law.
• When authorized by law to report information about certain abuse, neglect or domestic violence to public authorities.
• For public health oversight activities authorized by law.
• For certain judicial or administrative proceedings.
• For certain law enforcement purposes
• To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law; and funeral directors, consistent with applicable law.
• The Company may use or disclose Protected Health Information for research, subject to conditions.
• For the purpose of facilitating organ, eye or tissue donation or transplantation.
• When consistent with applicable law to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
• To the extent necessary to comply with workers’ compensation or other similar programs established by law.

Required Uses and Disclosures
Upon your request, the Company is required to give you access to certain Protected Health Information in order to inspect and copy it.  Under certain circumstances, however, the Company may deny your request.

Use and disclosure of your Protected Health Information may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Company’s compliance with the privacy regulations.

Rights of Individuals
In the event any of the following provisions require you to submit a written request to exercise such right, you must submit such request to the Director of Quality, Home Health & Hospice Care, 7 Executive Park Drive, Merrimack, NH 03054.

Right to Request Restrictions and Confidential Communications of Protected Health Information
You may request that the Company restrict uses and disclosures of your Protected Health Information to carry out Treatment, Payment or Health Care Operations, or to restrict uses and disclosures to persons identified by you who are involved in your care or payment for your care. The Company is not required to agree to your request, however, unless otherwise required by law, the Company must permit a request for a restriction on disclosures to another health plan for purposes of payment or health care operations where the PHI pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full.

The Company will accommodate reasonable requests to receive communications of Protected Health Information by alternative means or at alternative locations.

You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your Protected Health Information or to request confidential communications of Protected Health Information.

Right to Inspect and Copy Protected Health Information
You have a right to request to inspect and obtain a copy of your Protected Health Information contained in a “Designated Record Set,” for as long as the Company maintains the Protected Health Information.

• “Designated Record Set” includes enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for a health plan, or other information used in whole or in part by or for the Covered Entity to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the Designated Record Set.

A home care patient’s clinical record (whether hard copy or electronic form)    must be made available to a patient, free of charge, upon request at the next home visit, or within 4 business days (whichever comes first). All other requests for PHI by a patient or legal representative must be “acted   upon” – either provided or denied with a full written explanation within 30 days.

You or your personal representative will be required to complete a form to request access to the Protected Health Information in your Designated Record Set.  If access is denied, you or your personal representative will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise your rights to review this denial and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.

Right to Amend Protected Health Information
You have the right to request the Company amend your Protected Health Information or a record about you in a Designated Record Set for as long as the Protected Health Information is maintained in the Designated Record Set.

The Company has 60 days after the request is made to act on the request.  A single 30-day extension is allowed.  If the request is denied in whole or part, the Company must provide you with a written denial that explains the basis for the denial.  You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your Protected Health Information.

You or your personal representative will be required to complete a form to request amendment of the Protected Health Information in your Designated Record Set.  Any request for an amendment must be in writing and provide a reason to support a requested amendment.

Right to Receive an Accounting of Protected Health Information Disclosures
Upon your written request, the Company will also provide you with an accounting of disclosures by the Company of your Protected Health Information during the six years prior to the date of your request.  However, such accounting need not include Protected Health Information disclosures made:  (1) to carry out Treatment, Payment or Health Care Operations; (2) to individuals about their own Protected Health Information; (3) prior to the compliance date; or (4) based on your written authorization.

If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided. If you request more than one accounting within a 12-month period, the Company will charge a reasonable, cost-based fee for each subsequent accounting.

Right to Notification of Breach of Unsecured Protected Health Information.
In the event that a breach occurs with regard to your Protected Health Information, you have the right to be notified of the breach.

Right to Paper Copy of Electronic Notice of Privacy Practices.
If you received this notice in electronic format, upon your written request, the Company will provide you with a paper copy at no cost.

A Note About Personal Representatives
You may exercise your rights through a personal representative.  Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your Protected Health Information or allowed to take any action for you.

The Company retains discretion to deny access to your Protected Health Information to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.

The Company’s Duties
The Company is required by law to maintain the privacy of Protected Health Information and to provide patients with notice of its legal duties and privacy practices.  This notice is effective beginning September 13, 2013 and the Company is required to comply with the terms of this notice.  However, the Company reserves the right to change its privacy practices and to apply the changes to any Protected Health Information received or maintained by the Company prior to that date.

If a privacy practice is changed, a revised version of this notice will be either mailed to you or posted on our website.  In the event the revised notice is mailed to you, it shall be provided by first class mail to your last known address.  Any revised version of this notice will be distributed/published within 60 days of the effective date of any material change to the uses or disclosures, the individual’s rights, the duties of the Company or other privacy practices stated in this notice.

Minimum Necessary Standard
When using or disclosing Protected Health Information or when requesting Protected Health Information from another Covered Entity, the Company will make reasonable efforts not to use, disclose or request more than the minimum amount of Protected Health Information necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations.  However, the minimum necessary standard will not apply in the following situations:

• disclosures to or requests by a health care provider for treatment;
• uses or disclosures made to the individual or pursuant to your authorization;
• disclosures for compliance made to the Secretary of the U.S. Department of Health and Human Services;
• uses or disclosures that are required by law; and
• uses or disclosures that are required for the Company’s compliance with legal regulations.

Your Right to File a Complaint with the Company or the HHS Secretary
If you believe that your privacy rights have been violated, you may complain to the Company in care of the following officer:  Director of Quality, Home Health & Hospice Care, 7 Executive Park Drive, Merrimack, NH 03054 , or you may call 603.882.2941

You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C.  20201.

The Company will not retaliate against you for filing a complaint.

Additional Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact the following officer:  Director of Quality, Home Health & Hospice Care, 7 Executive Park Drive, Merrimack, NH 03054.

The HIPAA Privacy Rule is set out at 45 Code of Federal Regulations Parts 160 and 164.  These regulations and additional information about the HIPAA Privacy Rule are available at http://www.hhs.gov/ocr/hipaa/.

12/2018

Notice of Nondiscrimination/Filing a Grievance

Home Health & Hospice Care complies with applicable federal civil rights laws and does not discriminate, exclude or treat people differently on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, marital status, familial status, or any other characteristic protected by applicable federal, state, or local law and regulations in regards to admission, access to treatment, or employment.

Home Health & Hospice Care provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic formats, other formats); and free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact the Human Resources Department.

If you believe that Home Health & Hospice Care has failed to provide these services or discriminated in any other way, you may file a grievance in person or by mail, fax or email by using the contact information listed below. If you need help filing a grievance, contact our Director of Quality: Phone: (603) 420-1909; Fax (603) 423-9387; 7 Executive Park Drive, Merrimack, NH 03054.

It is the law for Home Health & Hospice Care not to retaliate against anyone who opposes discrimination, files a grievance or participates in the investigation of a grievance.

Grievances must be submitted to Home Health & Hospice Care within 60 days of the date you become aware of the possible discriminatory action, and must state the problem and the solution sought. We will issue a written decision on the grievance based on a preponderance of evidence no later than 30 days after its filing, including a notice of your right to pursue further administrative or legal action. You may also file an appeal of our decision in writing to our President/CEO within 15 days. Once an appeal is received a written response will be issued within 30 days.

The availability and use of this grievance procedure does not prevent you from pursuing other legal or administrative remedies.

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by using any of the following methods:
• Submit electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.
• Write to U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F. HHH Building Washington, D.C. 20201. Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html
• Call 1-800-368-1019 (toll free) or 1-800-537-7697 (TDD).

Discharge, Transfer and Referral Policy

We may only discharge or transfer you from this agency if:

• It is necessary for your welfare, and your physician who is responsible for your home health plan of care and our agency agree that we can no longer meet your needs based on your acuity level. We must arrange a safe and appropriate transfer to another care provider when your needs exceed our agency capabilities;
• You or your payer will no longer pay for the home health services;
• Your physician who is responsible for your home health plan of care and our agency agree that the measurable outcomes and goals of your plan of care have been achieved and you no longer need home health services;
• You refuse services or elect to be transferred or discharged;
• Our agency closes;
• Our agency determines, based on our policy, that your behavior or the behavior of other persons in your home is disruptive, abusive, or uncooperative to the extent that delivery of your care of the ability of our agency to effectively operate is seriously impaired. Prior to discharging for cause, our agency  must:
  • Advise you, your representative, if any,  your physician(s) issuing orders for your home health plan of care, your primary care practitioner or any other health care professional who will be responsible for providing care and services to you after discharge from our agency that a discharge for cause is being considered;
  • Make efforts to resolve the problem(s) presented by your behavior or the behavior of other persons in your home or situation;
  • Provide you and your representative, if any, with contact information for other agencies or providers who may be able to provide your care; and
  • Document in your medical record the problem(s) and efforts made to resolve the problem(s).

Discharge planning will be begin when you are admitted to the agency based on the findings of the comprehensive assessment performed at admission. You and/or your representative will receive education and training to facilitate a timely discharge. Any revisions related to plans for your discharge will be communicated to you, your representative, your caregiver, all physicians issuing orders for our agency plan of care, your primary care practitioner and any other health care professionals who will be providing care and services to you after discharge from our agency.

You will be given advance notice of your discharge or transfer to another agency in accordance with applicable state regulations, except in the case of an emergency. All discharges or transfers will be documented in your medical record. When a discharge occurs, an assessment will be done. You will receive an updated list of your current medications along with any instructions needed for ongoing care or treatment. We will coordinate referrals to available community resources as needed.

Following your discharge or transfer, we will send a discharge or transfer summary within the time frames specified by federal regulations to your primary care practitioner or other health care professional who will be providing care and services to you after discharge or transfer from our agency. The summary may include, but will not be limited to, a list of your current medications and information necessary for your continued care, including pain management.

If you elected to transfer from another agency and were under an established plan of care, Medicare requires us to coordinate the transfer. The initial home health agency will no longer receive Medicare payment on your behalf and will no longer provide you with Medicare covered services after the date of your elected transfer to you agency.

You or your authorized representative will receive and be asked to sign and date a Notice of Medicare Non-Coverage (NOMNC) at least two days before your covered Medicare services will end. If you or your authorized representative are not available, we will make contact by phone, and then mail the notice. If you do not agree that your covered services should end, you must contact the Quality Improvement Organization (QIO) at the phone number listed on the form no later than noon of the day before your services are to end and ask for an immediate appeal.

Complaint Procedure

All complaints regarding “Patients’ Rights” contained in State of New Hampshire RSA Section 151:21-b should be directed to the Clinical Manager of HHHC by calling 603-882-2941 between the hours of 8:o0 a.m. and 5:00 p.m. Monday through Friday. You may also submit a written complaint to Director of Quality, Home Health & Hospice Care, 7 Executive Park Drive, Merrimack, NH 03054, or you may call 603-882-2941. Most problems can be solved at this level. You may also notify the Administrator listed on the back cover of this booklet by phone or in writing. If you remain dissatisfied, please contact:

Persons 60 Year of Age or Older:

Bureau of Elderly and Adult Services
129 Pleasant St., Concord, NH 03301
603-271-9203 or 1-800-852-3345 ext. 4680

Office of the Ombudsman
NH Department of Health and Human Services
129 Pleasant St., Concord, NH 03301
603-271-6941 or 1-800-852-3345 ext. 6941
Hours of Operation:
Monday-Friday, 8:00 a.m. to 4:30 p.m.

MEDICARE HOTLINE
1-800-MEDICARE (1-800-633-4227)

Persons Under 60 Years of Age:

Department of Health and Human Services, Office of Operations Support, Health Facilities Adminstration-Licensing
129 Pleasant St., Concord, NH 03301
1-800-852-3345 ext. 9499 or 603-271-9499
TTY/TDD 1-800-735-2964
Fax: 603-271-4968
Hours of Operation:
Monday-Friday, 8:00 a.m. to 4:00 p.m.

You may also contact the state’s toll-free home health care phone at 1-800-621-6232 which operates from 9:00 a.m. to 4:00 p.m. Monday through Friday (except holidays). If the voicemail answers, please leave a message and your call will be returned. The purpose of this phone is to receive complaints or questions about local home health agencies and to make complaints concerning the implementation of advance directive requirements.

Notice of Medicare Non-Coverage

Patient Name_____________________________________________

Patient Number__________________________

The Effective Date Coverage of Your Current Home Health Services Will End:________________________________

• Your Medicare provider and/or health plan have determined that Medicare probably will not pay for your current home health services after the effective date indicated above.
• You may have to pay for any services you receive after the above date.

 Your Right to Appeal This Decision

• You have the right to an immediate, independent medical review (appeal) of the decision to end Medicare coverage of these services.  Your services will continue during the appeal.

• If you choose to appeal, the independent reviewer will ask for your opinion.  The reviewer also will look at your medical records and/or other relevant information.  You do not have to prepare anything in writing, but you have the right to do so if you wish.

• If you choose to appeal, you and the independent reviewer will each receive a copy of the detailed explanation about why your coverage for services should not continue.  You will receive this detailed notice only after you request an appeal.

• If you choose to appeal, and the independent reviewer agrees services should no longer be covered after the effective date indicated above;
  • Neither Medicare nor your plan will pay for these services after that date.

• If you stop services no later than the effective date indicated above, you will avoid financial liability.

How to Ask For an Immediate Appeal

• You must make your request to your Quality Improvement Organization (also known as a QIO).  A QIO is the independent reviewer authorized by Medicare to review the decision to end these services.

• Your request for an immediate appeal should be made as soon as possible, but no later than noon of the day before the effective date indicated above.

• The QIO will notify you of its decision as soon as possible, generally no later than two days after the effective date of this notice if you are in Original Medicare. If you are in a Medicare health plan, the QIO generally will notify you of its decision by the effective date of this notice.

• Call your QIO at:  KEPRO 1-888-319-8452 (TTY-855-843-4776) to appeal, or if you have questions.

If You Miss The Deadline to Request An Immediate Appeal, You May Have Other Appeal Rights:

• If you have Original Medicare:  Call the QIO listed.

• If you belong to a Medicare health plan:  Call your plan at the number given below.

Plan contact information:

Additional Information (optional):

Please sign below to indicate you received and understood this notice.

I have been notified that coverage of my services will end on the effective date indicated on this notice and that I may appeal this decision by contacting my QIO.

Signature of Patient or Representative__________________________________

Date___________________________