If you are the first clinician in the home (PT, OT, ST) , admission and consent forms are required for the patient to sign.

Always review Agency Policies, Patient Rights & Responsibilities, Advance Directives, Emergency Preparedness (Level I, II, III), Home Safety, Infection Prevention & Control and Emergency Care Plan. Review Face to Face encounter requirements (90 days prior or 30 days after the SOC date)

Forms required by the State of Colorado, signed by the patient/caregiver and the clinician include:

• Admission Consent

• Written Consent form

• Written notice of Home Care Consumer Rights

• Emergency Preparedness

• Agency Disclosure

• Patient Calendar Posted in patient home (written notification of when therapy is scheduled)

Extra Forms: 

• HHABN – (Reason for insurance not to pay; for example: due to not being homebound with early DC)

• HHCCN – (MD orders for HC have changed or agency has decided to stop giving home care)

• LACE – Rehospitalization risk based on scoring mechanism

• Mini Cog Test – Determine need for add on ST evaluation for cognition, Determine cognitive status

ATS Annual Attestation Powerpoint

RESTAFFING PROTOCOL: If you would like to restaff your patient to an assistant, see below. If you would like to restaff your patient to another PT/OT or ST, please contact the ATS Task Force first for assistance.

COLORADO Supervision Regulations:

COTA Supervision Requirements

PTA Supervision Requirements

Process:

1. SOLI - You will be assigned patients in the following way: (PT/OT teams below)

   • PTA/COTA will express interest in SOLI on a patient. ATS Task Force will include the PTA/COTA name and interest level for the evaluating therapist to consider once eval or SOC has been completed.

   • Evaluating therapist informally texts/calls the assistant, to see if the PTA/COTA are still willing to accept a new pt. For Restaffing, the evaluating therapist will informally text/call a therapist to see if they are willing to accept a patient for restaffing purposes.

   • If yes, the Therapist sends formal email to office (cc PT/PTA/OT/COTA) for request to assign PT/PTA/OT/COTA to pt in SOLI.

   • As an assistant, if you are concerned about your caseload, please first discuss with your PT and OT team members per the attachment ‘PT/OT assistant teams,’ as well as the ATS Task Force.

2. SOLI - Once patient is assigned, the patient will show in Pending Evaluations, Pending Approval or Active in SOLI. Once evaluated, the supervising therapist will contact you in regards to the POC.

   • Please review all written evaluation/POC documentation prior to seeing the patient.

3. SOLI - WAIT for the therapist to tell you that a VO (verbal order) has been received before calling the patient to schedule.

4. Frequency - REVIEW the frequency tool, as the frequency in SOLI includes the Therapist Evaluation, the Re-eval and DC (all of which have to be completed by the supervising therapist.

Tips:

• Communicate with your supervisor often

• Document your daily communication with the supervising therapist

• Make sure you pay attention to frequency set

• Make sure the re-evals (once every 30 days at least) and DCs are plotted correctly

• Refer to the Frequency Tool if you have questions

• Use ATS Kinnser to view the patient calendar for plotted visits. This will give you a visual cue on what weeks you need to see the patient.

• If patient is not ready for DC, please communicate with the therapist before the therapist re-evaluates.

Activation & Deactivation Policy
Revised: 6/16/2020

Summary: Clinicians may be activated or deactivated temporarily, or permanently. This policy was adopted to outline protocol for activating and deactivating clinicians contracted with Alpine Therapy Services, LLC. This policy will be made available to contracted therapists for reference. 

Alpine Therapy Services recognizes that not all reasons for activation or deactivation can be anticipated; therefore, this policy will cover most likely reasons. Situations not explicitly outlined within this policy will be reviewed on a case by case basis. 

Eligibility for Reactivation does not guaranty approval and will be evaluated on a case by case basis. See guidelines below to determine eligibility status.

Activation – New Hires:

Clinicians must be activated before they may perform any patient visits. Prior to eligibility and throughout the duration of contract, all required documentation must be on file, accurately completed, and current. It is the responsibility of each clinician to ensure they have received any required vaccines, evidence of insurance, and licensure required by Alpine Therapy Services, LLC and/or the contracted agencies.

Activation/Reactivation – Existing Contracted Therapists: 

An Existing Contracted Therapist is defined as a clinician who has seen a patient(s) within the past 45 days and was temporarily deactivated.

Clinicians with an ‘deactivated’ status must receive approval from the Chief Executive Officer or Chief Operating Officer AND all required clinician documents must be on file, accurately completed, and current. The reason for deactivation will be given consideration in the decision of whether the clinician will be reactivated. 

Activation/Reactivation – Former Contracted Therapists:

Former Contracted Therapists are defined as clinicians who have not seen a patient(s) in more than 45 days (or less if contract with ATS was terminated).

Clinicians with an ‘deactivated’ status must receive approval from the Chief Executive Officer or Chief Operating Officer AND all required clinician documents must be on file, accurately completed, and current. The reason for deactivation will be given consideration in the decision of whether the clinician will be reactivated. 

Deactivation – Contract Terminated by Therapist Request:

Eligible for Reactivation: Yes, upon approval. Contracted therapists of ATS may choose to terminate their contract in accordance with the terms of the signed agreement. The clinician’s status will be changed to ‘deactivated’ at that time. Deactivated clinicians may request reactivation at any time. Reactivation is subject to approval and required that all required documents are on file, accurately completed, and current.

Deactivation – Contract Terminated by Alpine Therapy Services, LLC due to lack of required documentation:

Eligible for Reactivation: Yes. At the time of onboarding and periodically thereafter, clinician files will be audited to confirm that all required information is on file, complete, and current. Additionally, the portal for clinician documentation alerts clinicians based on the expiration dates entered into the system. 

Regardless of any internal reviews that may be performed, it is the responsibility of each clinician to ensure information is on file, as required. Upon receiving results of an internal audit, clinicians will be notified of any exceptions and expected to address them within a reasonable amount of time (a due date of approximately two weeks is given with the initial communication of audit results). If the clinician does not address the findings prior to the due date, a second notice will be sent requesting that the issues be addressed right away.  If findings are still not addressed within a short period of time following the second notice, the clinician will receive a notice of deactivation. Any open current patients will be reassigned to other clinicians.

Deactivation – Contract Terminated by Alpine Therapy Services, LLC:

Eligible for Reactivation: No. As a contract therapists for Alpine Therapy Services, LLC, and in accordance with the signed agreement, the contract may be terminated at the company’s direction. If a clinician’s services are deemed to be unsatisfactory, the clinician will be deactivated and ineligible for reactivation. The clinician will be notified of the deactivation at that time. 

Deactivation – Contract Terminated Due to Inactivity:

Eligible for Reactivation: Yes, upon approval. As a contract therapist of Alpine Therapy Services, LLC, clinicians have control over the volume and frequency of their patient load. While there is no minimum number of patients that must be seen to remain in active status, if more than 45 days lapse without any patient visits, the clinician will be deactivated due to inactivity. 

Deactivated clinicians due to inactivity are eligible for reactivation subject to approval, once all required documents have been reviewed to ensure they are on file, complete, accurate, and current. Any exceptions noted must be addressed prior to the clinician being reactivated. 

Printable Form Here

HIPAA PRIVACY-RELATED COMPLAINT REPORT FORM: Please use this template to file a Health Insurance Portability and Accountability Act (HIPAA) Privacy Complaint.  

Complainant’s Name:________________________________________________

Telephone #:___________________ Email: ______________________________

Address:_________________________________________________________

Date(s) Action Occurred: __________________________________

Describe situation and effect on privacy (attach separate sheet, if needed): _______________________________________________________________

If you have witnesses, please provide names and contact information:

_______________________________________________________________

Describe how you feel your complaint could be resolved:

_______________________________________________________________

Alpine Therapy Services, LLC will not intimidate, threaten, coerce, discriminate, or retaliate against or take other retaliatory action against any person who participates in the complaint process or who opposes any act or practice made unlawful by the HIPAA Privacy Regulations.  Any person who believes he/she has been subject to such action should report it to the HIPAA Privacy Officer at (719) 258-7464.

COVID Vaccine Policy & Procedure

All employees, direct contractors, and support staff who have direct contact with patients will be required to have the COVID 19 vaccine to encourage and promote the benefits associated with vaccinations against COVID 19. Subsequently the employees will be required to have the subsequent booster shot at appropriate times mandated by the Advisory on Immunization Practices (ACIP).

The Agency shall provide employees with pertinent information regarding benefits and availability of immunization and importance of adhering to standard precautions.

If someone has a medical exemption, the ATS Medical Exemption form must be filled out by the appropriate and parties and be submitted to the agency for approval.

______________________

Purpose: To follow procedures established in the CDPHE standards to reduce the risk of occupational exposure to COVID 19 and its variants.

_____________________

Reference: Standards for Hospitals and Health Facilities, Chapter 2- General Licensure Standards, 6CCR 1011-1, Department of Public Health and Environment 

______________________

Related Documents: Employee Information Sheet:  Base and Purpose Issued from the State of Colorado 

______________________

Definitions:

1. “COVID 19 Vaccine" means a currently used vaccination approved through the Executive Order D 2020 003.

2. "Proof of Vaccination" means the vaccination card that a person receives for the vaccines administered

3. “Employee, direct contractor, and support staff” means an individual who has the potential for exposure to clients of the agency and/or to infectious materials, including bodily substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air

Procedure: Here’s what we need from you:

1. Vaccination card demonstrating you’re fully vaccinated OR

2. Completed CDC declination form AND a signed medical exemption form

Important notes:

1. A single religious exemption requires that the agency submits a waiver request to the state for approval from the state that the agency as a whole is honoring a religious exemption. There is no guarantee that the state will approve the agency waiver request. For this reason, most all contracted agencies are not accepting religious exemptions. For this reason, Alpine Therapy Services is also not accepting religious exemptions at this time. 

2. A medical exemption must be completed and signed by a physician, physician assistant, advanced practice nurse or certified midwife certified by the state of Colorado (not signed by an out of state practitioner). The exemption reason must be a medication or diagnosis contraindication documented on the product labeling (the vaccine product insert)

Contraindications to the Moderna Vaccine

You should not get the Moderna COVID-19 Vaccine if you: • had a severe allergic reaction after a previous dose of this vaccine • had a severe allergic reaction to any ingredient of this vaccine WHAT ARE THE INGREDIENTS IN THE MODERNA COVID-19 VACCINE? The Moderna COVID-19 Vaccine contains the following ingredients: messenger ribonucleic acid (mRNA), lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate trihydrate, and sucrose.

Contraindications for the Pfizer Vaccine

Serious allergic reaction (e.g., hives, swelling of the mouth or throat, difficulty breathing, low blood pressure, or shock) after receiving a previous COVID vaccine or to any of the following vaccine components: • (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate) • 2[(polyethylene glycol)-2000]- N,N-ditetradecylacetamide, • 1,2-distearoyl-sn-glycero-3-phosphocholine, and 0.2 mg cholesterol) • potassium chloride • monobasic potassium phosphate • sodium chloride • dibasic sodium phosphate dihydrate • Sucrose. Less than 16 years of age

1. You will be responsible for testing per the risk category for the state of Colorado - currently we are at a moderate risk for COVID, therefore weekly tests are required. If the risk raises to HIGH - COVID testing must be completed twice a week. According to recent data, religious exemptions have not been approved by the health department - I am waiting to hear back for clarification on this. You are still required to wear masks when treating patients and follow all CDC guidelines for transmission control - visit our COVID website for a refresher if necessary. 

2. For any exemption, the agency must require that the clinician have a viral test once a week and those results will be kept on file for easy access. This frequency of testing is for areas with a moderate level of transmission. If at any time we move to a high community transmission, we will be required to move to viral testing 2 times a week and daily rapid testing, and results must be in the agency documentation. Any required testing would be paid for by the clinician, scheduled by the clinician and the results must be sent to the agency by the clinician.

ATS Action Plan:

We need you and the last thing we want to do is deactivate you as a clinician. ATS is required to be in compliance as of October 1, 2021. Not only are our agency’s hands tied, but ours are as well. 

Any clinician without a vaccine card or CDC declination with medical exemption will be deactivated as of October 1, 2021.

For clinicians who decline the vaccine and provide the medical exemption as outlined above, you will remain active, as long as you continue to provide regular test results through SOLI. Failure to provide these results on time, will result in deactivation. 

We will be making updates to SOLI to make tracking easier for medical exemptions and regular testing. In the meantime, please send your medical exemption forms and test results to hr@alpinetherapyservices.com. CDC declination forms are to be uploaded to the COVID vaccination or declination category already on SOLI. 

1. Major Medical: (303)-654-0720

https://www.majormed.com/

2.Advanced Medical Solutions: (800)-248-2229

https://www.amsdme.com/

3. Mountain View Medical Supply: (800)-873-7121

https://mvmsinc.com/

4. Assistance League of Denver: (720)-638-3650

https://www.assistanceleague.org/denver/

5. Independently Yours Medical Supplies: (303)-840-4444

https://independentlyyours.org/

6. RTD/Access-A-Rode/Senior Ride: (303)-299-6000

https://www.rtd-denver.com/services/access-a-ride

Medicare Coverage: https://www.colorado.gov/pacific/hcpf/durable-medical-equipment

Dress Professionally – Remember you are marketing yourself

• Most of the ATS team either wear scrubs or dress business casual. Dress to impress! Don’t forget to check out the apparel line on the ATS website. 

• Professional dress portrays an image of confidence and security for patients. Cleanliness and neatness are absolutely necessary at all times. 

• Have your nametag in view, especially on first encounters at time of evaluation. 

• Appearance and perception play a key role in patient service. The goal is to be dressed professionally.

Dress Code:

• No Open Toe Shoes (this is an OSHA regulation)

• No ripped jeans or pants

• No company logos that could be confusing to a patient (ex. you work PRN at a hospital and wear hospital logo clothing to a home health visit for ATS = confusion)

• No distracting themes, low cut clothing, exposed midriff, evening wear, or sheer clothing is considered appropriate.

• Please cover all body art as this is a request for all companies we contract with.

ATS TASK FORCE: A team of therapists who are closely monitoring changes related to any type of emergency situation. The team consists of the CEO, CMO and CRO. 

Where can I find it? Details will be distributed by email

What to watch for: Daily updates from HHAC, CMS, CDC and Colorado Government driven protocols

Emergency Phone Tree: Used to assist with communication as a TEAM. If you have an emergency situation, PLEASE call and speak to someone on the ATS Task Force (do NOT leave a message, as you must speak to one of the members on the task force first); If you speak to the ATS Task Force Members, they will in turn notify the CEO (if not notified prior) who will then notify the ED for each individual company for protocol purposes.

What to watch for:

• Prevention of spreading infectious diseases, monitoring natural disasters and safety of the patients in our care, monitoring safety of ATS therapists. 

• ALWAYS communicate with other members also treating the same patient (i.e. the other therapists treating the patient). 

Items recommended for your car:

• Trash bag or large ziplocks (clean and dirty bags) for items you doff at your car and not inside the patient home. Inside the patient home, it is recommended to dispose trash in their trashcan as it is cross contamination to bring trash to your car from the patient home. 

• Large plastic bins with lids for infection control purposes and HIPAA protection to consist of HEP, SOC books, paperwork, extra supplies, PPE and a bin for your bag unless you have rubber mats and a roller bag. 

  • Clean & dirty areas that are wipeable  (i.e. a plastic tub with HEP, SOC books, protocols and clean medical supplies separated from paper products AND a plastic tub to place your bag). If you have rubber mats and a rolling bag, you can place your bag on the rubber mat as it is wipeable and the bottom surface of your bag is not touching the surface of your car)

  • Recommended for patients: when you get to your car, remove all PPE to include gloves first, place in ‘dirty’ ziplock, use hand sanitizer and then doff your mask and eye wear – spray eye wear and mask with Lysol or hydrogen peroxide and place in a ‘clean’ ziplock. 

  • Please pay attention to droplet precautions vs airborne precautions for infection control measures

Electronic Verification Visit (EVV) is required for all Medicaid patients. It is completed by checking in and out of a portal on your mobile device. EVV finds your location and authenticates you were present at the patient’s address for the time period you are billing for. You are required to utilize EVV for every visit to get paid and to bill agencies.

Examples of EVV Agencies may use are:

• Kinnser EVV

• CellTrak

• Sandata

• Axxess

• Kantime

• Carefficient

You can find out which EVV your patient has on SOLI by:

1. Click on patient chart

2. View and open at the top: “Important Notes”

All forms are to be completed and/or uploaded in the SOLI app. If you can’t find what you’re looking for email hr@alpinetherapyservices.com

• Annual Inservice Attestation Checklist
  Annually, you are required to certify that you have received training/refresher training on pertinent information. This checklist certifies that you have received the information and completed the training for the year. 

  NOTE: Make sure the form is signed AND dated. Expiration date on Soli should be one year from the date of the most recently completed form

• Auto Insurance Policy
  You must have a current auto insurance policy as you are driving your personal vehicles to see patients.

  NOTE: Make sure the evidence of insurance that you upload makes your NAME and POLICY DATES visible • Expiration date on SOLI should be the date your policy renews. If you’ve changed carriers, vehicles, or have made any other changes to your policy, it is imperative that you upload the current policy information as soon as possible.

• Background Check Authorization
  Authorizes ATS to obtain a background check for employment purposes. This is performed at the time of hire and may be performed throughout contract term.

  NOTE: Make sure form has been properly completed, signed and dated.

• Background Check Form
  This is the form you complete with name, address, etc. so that they can make sure the background report correlates to the correct person.

  NOTE: Make sure form is complete, signed, and dated.

• Background Disclosure
  Not to be confused with the Authorization form, the Disclosure form is provided to you at the time of hire. The signed form demonstrates that the proper disclosure was provided to you at the time you gave authorization for the report to be generated.

  NOTE: Make sure the form is signed and dated.

• CPR Card
  Evidence that you are current on obtaining or recertifying your CPR training

  NOTE: Make sure your name is visible as well as the date of certification • Expiration date on SOLI should be two years from the date of training completion.

• Direct Deposit Form
  This form includes your bank account and routing number information so that your pay can be directly deposited into your account.

  NOTE: Double check the account number and routing number on the form prior to submitting. Make sure form is complete. If you change financial institutions or account numbers, make sure you submit a new form with updated information.

• Driver’s License
  State Issued Driver’s License

  NOTE: Make sure we have your CURRENT state issued DL on file. If you have moved, make sure the DL is updated in a timely manner and re-uploaded accordingly. Please make sure the expiration date of your current DL has been entered.

• Flu Vaccine or Declination
  Evidence that you have received the vaccine for the current flu season (begins Oct of each year). OR a completed signed declination form for the current flu season (begins Oct of each year).

  NOTE: Make sure your vaccine is current, or if you’ve declined, a new form must be completed for each flu season. Expiration date on SOLI for vaccine OR declination should be October 1 of the next flu season (whether you received the vaccine in October of 2019 or January of 2020, the expiration date would be October 1, 2020). Make sure the evidence of vaccine shows the date obtained and your name. If declining, complete form certifying that you have declined the flu vaccine for the current flu season (begins Oct of each year), acknowledge the risks/liability, and have provided a valid reason for declination.

  NOTE: If you’ve already had a vaccine at the time you are hired, THIS IS NOT CONSIDERED A DECLINATION. You will need to submit evidence of your flu vaccine. • Make sure declination form is complete.

• Hep B or Declination
  This will be one of two things – 1) A completed declination form OR 2) evidence of your Hep B vaccine.

  NOTE: You will ONLY complete the form if you have declined the vaccine. • If you have received the vaccine, you will upload evidence of your Hepatitis B vaccine in this section What to watch for: • Make sure the form is properly completed, signed, and dated. • If you completed the acceptance portion of the form, you are required to provide evidence (see next section below). 

• Job Description
  Written job description for your respective role. Form must be signed and dated. 

• Professional Liability Insurance
  We are required to retain evidence of your current liability coverage on file for each clinician.

  • What to watch for: • Make sure your name and coverage dates are visible and legible • Make sure the expiration date on SOLI matches your policy. Professional License What is it? • License to practice as PT, ST, OT, PTA, COTA, etc. What to watch for: • Make sure this is on SOLI, shows your full license, and is legible. 

• Profile Picture Image
  Your profile picture (headshot) will be available to ATS and agencies. It does not need to be formal but should be current.

  NOTE: Picture should be current and should not include other people. A headshot is preferred for easier recognition. Profile pictures do not have an expiration date; however, you are encouraged to update at least once every five years. 

• Resume and References
  We are required to have your resume on file for our agencies. References can be listed as ‘available upon request’ but please make sure these are accessible and can easily be provided when needed.

  If the document is multiple pages, we need to have all pages. You can email them to ATS to upload in Word or PDF if needed. Make sure references are accessible and can easily be provided upon request if not included with resume.

• TB Questionnaire
  This form asks several questions regarding indicators of TB. This form must be on file for each clinician.

  Form needs to be complete, signed, and dated. TB Test What is it? Evidence of a baseline TB skin or blood test conducted. As of February 2020, only one TB test is required and not expected to be completed every year. Make sure what we have on file is proof of the test, inclusive of your name and date of test/results. Test should be done annually. 

• TB Test – 2 Step or Gold Test TST is used to test health care personnel because some people with latent TB infection have a negative reaction when tested years after being infected. The first TST may stimulate or boost a reaction. This test is considered the GOLD test as it is the most accurate and only needed once.

  NOTE: Make sure your name and results are visible on the image uploaded. 

• W-9
  An IRS Tax Form which is used to confirm your name, address, and taxpayer ID number for employment or other income-generated purposes.

  NOTE: Make sure form is completed. This form does not have to be re-completed each year; however, if there are ANY CHANGES OR UPDATES to your name, address, or taxpayer ID, you will need to complete an updated form at your earliest convenience.

Frequency is the number of visits per week set at initial evaluation, to include the evaluation and discharge visits. 

PT/OT/ST Frequency: 

• It is important to mix frequencies and not use a ‘cookie cutter’ frequency such as 2w8, unless you can back it in your evaluation/SOC and is agreeable by the contracted company. Front loading visits is recommended with new PDGM changes in 2020. 

• Frequency goes from Sunday to Saturday for most all companies besides Argus HH! If you can’t make up a visit during the Medicare work week, you either need to change frequency or complete a missed visit. Missed Visits are not recommended as contracted company’s track these weekly and is often frowned upon FYI. 

• TOTAL frequency means the number of visits by all therapists. Example, PT (2w3), OT (2w3), ST (2w3) = 18 total visits. We should never exceed 22 visits total for all disciplines in a certification period (60 days from SOC date) without discussing with the contracted company. When in doubt, go to patient manager in ALPINE KINNSER, click the tab “ALL THERAPY” which will show the number of visits total by all therapists. 

• Effective dates must be the same as the evaluation date, to include 1w1 for the evaluation for example. 

• The certification period must be considered for all frequencies. 

• The frequency in SOLI must match what you are completing in the contracted company EMR system. 

  • Example: PT frequency is 2w2, 1w5 = 9 PT visits, effective 3/11/2020 – this includes one visit for the evaluation, re-evaluation and discharge.

  • Example: OT frequency is 1w2, 2w1, 1w1 = 5 total OT visits, effective 3/14/2020. This includes one visit for the evaluation, re-evaluation and discharge.

  • Example: SLP frequency is 1w1, 2w3, 1w2 = 9 total SLP visits, effective 2/13/2020. This includes one visit for the evaluation, re-evaluation and discharge.

• ASSISTANTS frequency: 

  • A PT or OT must complete a re-evaluation every 30 days in place of a visit by an assistant. 

  • Keep in mind that the first visit of the frequency is done by the evaluating therapist. The last visit is completed by the therapist, and if a re-evaluation is needed it must also be completed by the PT or OT. 

  • When in doubt, look in ALPINE KINNSER under patient manager to view the calendar of plotted visits. 

  • Make sure to review the evaluation and re-evaluation completed by the PT or OT prior to seeing the patient for treatment to ensure accuracy of the frequency, to follow orders, and follow the POC. 

What to watch for:

• Change in frequency in SOLI, ALPINE KINNSER and in the contracted company EMR (requires VO from the MD, new order and comm note in some cases)

• HOLD status (requires a MD order, delete remaining visits in SOLI and Kinnser during a HOLD status) 

Make sure every patient is re-evaluated every 30 days, at least! It is everyone responsibility to plan ahead for re-evaluations. 

COTAs/PTAs should communicate with the evaluating/supervising clinician often for care coordination and questions regarding frequency as needed. 

Incidents - must be written in Kinnser using the incident template note (ex. patient fell and you are the first to see the patient since the fall)

Incident Reporting Material

Infections - must be written in Kinnser using the infection template note (ex. patient has a UTI, RN is not seeing the patient and therefore you must report the infection. When in doubt ask the ATS Admin team or Agency directly)

Infection Reporting Material

Precautions: What to Do at a Client’s Home & Clothing to Wear at Work

Wear clothing that can be washed then dried in a hot dryer. 

• Light coloured clothing makes it easier to see bed bugs. Choose pants without cuffs and shoes that are smooth with no trim that bed bugs can hide underneath.

• Be careful where you sit. The safest choice is a hard kitchen chair. Try not to sit on sofas and beds.

Equipment

• Take in the least amount of stuff possible. Things like bags, tool kits, and coats are good hiding places for bed bugs.

• Put a barrier under your bag or other equipment to isolate it from the room. A white plastic bag works well as a barrier. Bed bugs are not likely to crawl on it because it’s smooth. Using a plastic bag that is white makes bed bugs easier to see. Leave whatever you use as a barrier under your bag for the client to throw out.

Going Home after Work

• When you work in places that have, or may have bed bugs your biggest fear is bringing them home with you. Having a routine that will kill a bed bug that manages to hide on your equipment or clothing is a good way to stop this happening.

• Take off the clothes you were wearing in the bed bug infested building as soon as possible and before moving around in your home. A great place is a garage if you have one.

• If you don’t have a garage, take off any clothing that may be infested with bed bugs as close to the entrance door as possible. If you live in an apartment, the bathtub might be the best place. This is because bed bugs are easy to see on light surfaces and don’t like crawling on smooth slippery surfaces. 

• Put all your clothing in a plastic bag.

• Seal the bag and take it directly to the washing machine.

• If your clothes are still clean, put the clothes in a dryer on the hottest setting for 30 minutes. It is the heat of the hot dryer that kills the bed bugs.

• Don’t take clothes off in your bedroom.

Working with Clients Living with a Bed Bug Infestation

If your client lives in a home he or she (or their family) own they should call a pest control company for help to treat the bed bug infestation.

If you work in different homes during the day, be very careful not to transfer the bed bugs from one place to the other. If you know a place has bed bugs, visit it last. You can also wear a protective coverall so the bed bugs can’t crawl under a seam or in a pant cuff. ***Always know that if you are not comfortable seeing a patient with bed bugs, please discuss this with the ATS Admin Team. We will help!

What to watch for:

• Conceal all HIPAA information in a covered notebook, calendar etc. (i.e. make sure a bystander can’t see patient information by looking in your car). 

• PLEASE limit HIPAA information in your car in the event that your car is stolen!!!!! This would be a breach of HIPAA and is still considered the fault of the car owner and not the thief that stole your car. 

• Infection control is imperative for your car to prevent cross contamination between patients, or between your patients and your home. 

ATS INFECTION CONTROL MEASURES BEFORE/DURING/AFTER TREATING A PATIENT: A detailed plan to keep you and your patients safe and germ free, as well as to prevent cross contamination.

• WHAT TO WEAR: Pay attention to airborne precautions vs contact, universal, or droplet precautions and dress accordingly. Consider wearing scrubs, shoes that can be wiped down, gloves and disposable or reusable N95 masks, as well as protective eyewear for airborne and droplet precautions. Universal Precautions will be used primarily for the majority of your patients. 

  • BEFORE: Read patients PMH to ensure you have the correct materials for PPE. 

  • DURING: When in your car, have hand sanitizer available. Use trunk/car technique and bag technique!!! Wash your hands after treatment.

  • AFTER: After leaving the patient home, if you don’t doff gloves in patient home - doff gloves first and place in your car trash bag, sanitize your hands and then doff eyewear (clean and store in clean region of your car trunk). Clean hands with sanitizer in the trunk of your car, follow car infection control tech. If you are wearing a mask,  sanitize your hands then pull mask down between visits or take off, spray with Lysol or hydrogen peroxide and place in a clean ziplock.

    • Once home at the end of your day, we recommend you wipe down or spray your front seat of your car, steering wheel and steering controllers; then take off your scrubs and shoes immediately before or just after entering your home. WASH your scrubs immediately, as well as disinfect the reusable N95 mask or an original N95 mask. WIPEDOWN your shoes immediately and spray with Lysol if available. SHOWER ASAP to ensure you prevent germs in your home. 

  • GENERAL: 

    • AVOID touching your eyes, nose, and mouth 

    • AVOID close contact (less than 6ft) with people who are sick

    • Stay home if you’re sick

    • Cover your cough/sneeze with a tissue or into your arm sleeve. 

    • Clean and disinfect frequently touched objects such as your phone, computer, ipad, stethoscopes, pulse ox, thermometer etc. 

• BAG TECH https://www.youtube.com/watch?v=Hhi-o5IgKDk - bag technique (always use a bag barrier disposable or reusable, or a rolling bag for every visit). Consider only taking in necessary items in a smaller bag such as a ziplock, rather than your entire bag. If the patient is not a cardiac patient or not on O2 for respiratory conditions, you can ask the patient if they’d like their vitals taken, if not simply document ‘patient refused vitals at this visit.’ This will help save your PPE. 

• HANDWASHING https://www.youtube.com/watch?v=3PmVJQUCm4E – This is the BEST way to protect yourself and others. It is recommended to handwash before and after treating  a patient, or after three uses of hand sanitizer (be sure to use your own paper towels and never shake your hands or flick water before drying); wash your hand with soap and water for at least 20sec, wash between fingers, tops of hands, fingernails, wrists. If soap and water is unavailable, use sanitizing gel (95% alcohol) and rub hands together until dry. 

• DONNING/DOFFING TIPS FOR PPE https://www.youtube.com/watch?v=oxdaSeq4EVU PPE must be donned and doffed in a specific order to ensure you are not breaching your safety or the safety of the patient (i.e. donn mask before gloves, and remove gloves before removing mask; wash hands after removing gloves). A gown or goggles are not required unless the patient is on droplet precautions (not typically seen in the home health setting). 

What to watch for: Constantly monitor your PPE supply and order supplies in advance to prevent running out. Please reach out to the ATS TASK FORCE if you need additional supplies if you get in a bind. We have reusable N95 masks, as well as original N95 masks that have been made out of 100% cotton in three layers per the CDC recommendations. 

ATS PATIENT HOLD PROTOCOL:  When a patient wants to hold services due to fear of pandemic, concern related to natural disaster, etc. (If a therapist begins to feel ill, please contact the Staffing line 720-679-0313 for re-staffing). 

ATS PROTOCOL if patient is refusing an eval or SOC: 

• First Offer a HOLD 

  • Notify the contracted company

  • Notify the MD and write an order

  • Make a note to follow up with the patient once HOLD is lifted. 

• ATS PROTOCOL if hold is not wanted and a non-admit status is preferred by patient: 

  • Notify the contracted company

  • Notify the MD and write an order

  • Complete comm note describing reason for refusal (to include a hold was offered) 

  • Notify the treatment TEAM

  • Finally non-admit in SOLI and remove the visit in ALPINE KINNSER. 

• ATS PROTOCOL if a current patient wants a HOLD status. (HOLD status is recommended compared to a change in frequency at this time)

  • Use the ATS PHONE TREE immediately. CALL and speak to the ATS Task Force at 720-679-0020. The CEO will then call the ED for the individual contracted company to follow their individual protocols. 

  • Contact the team members also treating this patient. It’s INCREDIBLY important that we still act as a TEAM. EVERYONE needs to know if the patient is requesting a HOLD status. 

  • If you are the first clinician to report a HOLD request, you will need to call the MD to get a hold order for all disciplines and document as such. 

  • Write a comm note, as well as MD order depending on the contracted company protocol.

  • Make a note to follow up with the patient once HOLD is lifted.

  • FOLLOW UP with your hold patients once a week!!!! It is your responsibility to follow up with your patients. 

• GENERAL: 

  • Per CMS guidelines, the patient MUST be re-evaluated every 30days per conditions of participation. That means, if you hold a patient, you can only hold for the duration of 30 days max from the last re-evaluation or initial evaluation. 

  • If a re-evaluation is missed, you will need to call the contracted company to see if we need to complete a nonbillable DC, or continue to hold depending on the individual company protocols. 

  • If patient is on hold, ALL visits should be removed in the contracted company documentation system as well as ALPINE KINNSER, and NOT ‘missed.’

What to watch for:

• Tablet patients – If your patient is NOT on your tablet the day you are scheduled, CALL the company’s scheduler immediately as the patient may be on hold per patient request already. Do NOT see the patient is they are not on your tablet. Sync your tablets and update OFTEN. 

• Look in the chart for other web based EMR systems when in question of a hold status. Look under ORDERS and comm notes. 

Late Fees are added when documentation is submitted > 24 or 48hrs of the visit, and/or when documentation and billing is not completed in ATS Kinnser by midnight Sunday nights for the week prior. Questions, please ask. Warnings will be emailed, with the first two warnings being without charge followed by a third with a charge as below.

Evals/ReEvals/SOCs - All Evals/ReEvals need to be documented within 48 hours after visit. 

Visit Notes - need to be submitted within 24hrs per CMS guidelines

All Documentation & Billing - need to be submitted by midnight on Sunday each week to prevent late fees and to be paid timely.

Note Corrections / Timesheet Corrections – Our Administrative team may send you notes/ timesheets that need to be corrected. Please correct these within 24hrs to prevent billing and payroll delays.

Please always make sure you have all visit times and visit types completed in the ATS Kinnser. If you document in a different EMR and use ATS Kinnser for billing, the dates and times must match! Any late visits are subject to the late fee schedule.

ATS offers a Mentorship Program in which we will assign a mentor to you specifically to answer any questions, provide resources and overall support along this journey.

We want your first job experience to be memorable and valuable. At any time, if you feel overwhelmed, please reach out to your mentor or to your Team Leader. It has been said you only learn 25% of what is needed to succeed while in school. That said, we recognize this and will help you every step of the way! More importantly, we want to welcome you to the professional world and say ‘Thank you’ for choosing Alpine Therapy Services, LLC as your first employer!!! Let’s get started!

What is it?  When a patient wants to hold services due to fear of pandemic, concern related to natural disaster, hospitalization, vacation etc.

Where can I find it? (BELOW)

• ATS PROTOCOL if patient is refusing an eval or SOC, or wants to hold (meaning hold off on Eval or SOC): 

  • Notify the contracted company

  • Notify the MD and write an order

  • Make a note to follow up with the patient once HOLD is lifted. 

  • Place patient on hold in SOLI

• ATS PROTOCOL if hold is not wanted and a non-admit status is preferred by patient: 

  • Notify the contracted company

  • Notify the MD and write an order

  • Complete comm note describing reason for refusal (to include a hold was offered) 

  • Notify the treatment TEAM

  • Finally non-admit in SOLI and remove the visit in ALPINE KINNSER. 

• GENERAL: 

  • Per CMS guidelines, the patient MUST be re-evaluated every 30 days per conditions of participation. That means, if you hold a patient, you can only hold for the duration of 30 days max from the last re-evaluation or initial evaluation. 

  • If a re-evaluation is missed, you will need to call the contracted company to see if we need to complete a nonbillable DC, or continue to hold depending on the individual company protocols. 

  • If patient is on hold, ALL visits should be removed in the contracted company documentation system as well as ALPINE KINNSER, and NOT ‘missed.’

What to watch for in Point Care Tabs:

• Tablet patients – If your patient is NOT on your tablet the day you are scheduled, CALL the company’s scheduler immediately as the patient may be on hold per patient request already. Do NOT see the patient is they are not on your tablet. Sync your tablets and update OFTEN. 

• Look in the chart for other web based EMR systems when in question of a hold status. Look under ORDERS and comm notes. 

ATS uses ADP for all payroll information. Login to access your pay stubs and other pay information here: My.Adp.com

Holiday Pay Differential 

• If you are available and agree to visits for any of the major holidays or weeks as noted below, you will be compensated extra per visit (including visits, evals, re-evals, SOC OASIS visits). The breakdown is as follows: 

  • Memorial Day ($5)

  • Fourth of July ($5)

  • Labor Day ($5)

  • Thanksgiving Day ($10)

  • Day after Thanksgiving Day ($5)

  • Christmas Eve ($10)

  • Christmas Day ($10)

  • Week of Christmas (Bonus Opportunity – Please contact ATS task force if interested)

  • New Year’s Day ($5)

Standard Pay Rates Home Health (In Home or ALF) - PT/OT/SLP

• $70/visit (base)

• $75/evaluation or re-evaluation 

• $100/OASIS (base)

• $110/SOC OASIS (base)

• $20/Transfer OASIS

• $20/case conference (as needed)

• $5/supervision visit for PT/OTs supervising a COTA/PTA (internal)

• $5/supervision visit for external PTA/COTAs from an agency (external) 

PTA/COTA

• $50/visit (base)

• $20/case conference (as needed)

ST CFY Internship 

• $50/visit (base)

• $55/evaluation or re-evaluation (base)

• $70/OASIS (base)

• $10/Transfer OASIS

• $10/case conference (as needed)

MSW 

• $80/all visits and evaluations/re-evaluations (base)

OUTPATIENT or INPATIENT FACILITY HOURLY 

• PT/OT/SLP: $50/hour

• PTA/COTA: $40/hour

MOBILE OUTPATIENT PT/OT/ST

• $65/visit (4 units = 53mins) billed as Outpatient PT/OT/ST/MSW 1hr including discharge (45mins, 30mins, 15mins)

• $70/evaluation or re-evaluation (4 units + eval = 73 mins) billed as PT/OT/ST/MSW Evaluation*

Extra benefits (In addition to FLEXIBILITY!!!) 

• Supervision Differential = $5/visit that the COTA or PTA completes internally or externally (must be submitted as a supervision visit in Kinnser)

• $120 reimbursement per year for CEU memberships; a receipt must be emailed to jayme@alpinetherapyservices.com for reimbursement/year. Reimbursement requests must be completed within 60 days of the purchase for example with physicaltherapy.com, occupationaltherapy.com, speechtherapy.com (applies to those who see 25 units or more, on average per payroll) 

Travel Stipends: A $15 pre-approved agency stipend for any visit outside of a 35min radius, and outside of your area, and requested in SOLI prior to accepting the patient)

As a partner of Alpine Therapy Services, LLC, you are representing a therapy owned company that was built from ground up with a lot of hard work!! In an effort to maintain good status in the community and to prevent harm to patients under this organization, it is imperative to follow the correct resignation process as a contractual obligation. Per Section 21 of your personnel contract, you are required to give a 2 week notice by email to hr@alpinetherapyservices.com. If a 2 week notice period cannot be fulfilled, you must explain reasons why in writing to  hr@alpinetherapyservices.com Additionally, you must ensure that the patients assigned to you in your SOLI are restaffed appropriately according to their medical needs. ***Please do not resign via text message, as the professional process is to submit a resignation in writing via email.

Abandonment is a legal claim that occurs when a therapist terminates the professional relationship with a patient without reasonable notice and when continued care is medically necessary. Once a patient is assigned to you in SOLI, it is your responsibility to follow through with the plan of care.  

• Please remember, under the signed personnel agreement, you must give a 2 week notice period to allow for proper transitions with your patients for continuity of care purposes. If you resign without notice, and you have assigned patients to you in SOLI, you are committing patient abandonment, which will result in a formal report to the state of Colorado licensure program. Under the state of Colorado, a complaint for patient abandonment can result in deactivation of your professional license. 

Negligence is delay in health care, failure to seek timely and appropriate medical care for patients, failure to report patient endangerment placing the patient in a serious situation, as serious as possible death. Once a patient is assigned to you in SOLI, it is your responsibility to follow through with the plan of care. 

• Please remember, it is your contractual obligation to give a 2 week notice period to allow for proper transitions with your patients for continuity of care purposes. If you resign without notice, and you have assigned patients to you in SOLI, you are committing patient negligence, which will result in a formal report to the state of Colorado licensure program. Under the state of Colorado, a complaint for patient abandonment can result in deactivation of your professional license. 

Annual Inservice Packet

Direct Deposit Form

Flu Vaccine or Declination

COVID Vaccine or Declination

COVID Vaccine Declination Medical Exemption Form

Hep B Declination

TB Questionnaire

TB TEST Information

W-9

Taxes:

All therapists are 1099 contractors, which means therapists must manage their own taxes, benefits, and work methods. Therapists will receive a Form 1099-NEC (Non-employee Compensation) from clients reporting their earnings, instead of a W-2. Keep track of your receipts and spendings on the job as these details can be written off as expenses on your taxes! More information is provided under “Helpful Tools”.

Health Insurance:

Therapists are responsible for finding their own health insurance. ATS is not able to offer contract employees insurance at this time. ATS has resources which can be found under “Helpful Tools”. We recommend CO Health Brokers!

Liability Insurance:

Therapists are responsible for enrolling in professional liability insurance up to 3mill/1mill dollars. This documentation must be uploaded annually on to “SOLI: Credentialing”. We recommend HPSO!

Termination of Contract. ATS shall be entitled, in its sole and absolute discretion, to terminate this Agreement at any time with or without cause.. If a contractor wishes to terminate this Agreement, then it must send to ATS in writing notice of termination at least two weeks prior to the proposed termination date.  Contractor must assist with and complete transition plans for all patients during the notice period. Contractor’s written termination of this Agreement must be emailed to the Human Resource department and the CEO and must include the last date that the Agreement is in effect (which must be at least 2 weeks after the notice is sent). Contractor shall return all materials belonging to Alpine Therapy Services, including without limitation, tablets, name badges, all Confidential Information, and all other items, materials and resources provided to Contractor.  Contractor’s failure to return any of the foregoing items shall constitute a breach of this Agreement and ATS may impose on Contractor fines, or may pursue remedies available to ATS at law or in equity to cause the return of such items (plus costs and expenses of enforcement).

• Non-exclusivity.  This Agreement is not be exclusive as to Contractor or Organization. Contractor may market its services to the general public, but will not solicit or otherwise market its services to a Health Care Provider, a company or agency that has contracted with ATS or any patient/client to whom Contractor has provided Services to under this Agreement, or use any Confidential Information to accomplish same.  Moreover, Contractor shall not solicit or market its services to a Health Care Provider, any  agency that has contracted with ATS until expiration of twelve (12) months after the termination of this Agreement.

  • Injunctive Relief. Contractor acknowledges (i) the unique nature of the protections and provisions established and contained within this Agreement, (ii) that ATS will suffer irreparable harm if Contractor should breach any of said protections or provisions, and (iii) that monetary damages would be inadequate to compensate ATS for said breach. Therefore, should Contractor breach of any of the provisions contained within this Agreement, and then ATS shall be entitled to injunctive relief, in addition to any other remedies at law or equity, to enforce said provisions.  The foregoing provision shall not prohibit, in any manner, ATS from filing an action for monetary damages or other relief at law or in equity for a breach of this Agreement.

  • Permanent Placement. Should Contractor be offered or accept any offer for employment, compensation, or otherwise with any Health Care Provider, a company or agency that has contracted with ATS or any patient/client to whom Contractor has provided Services to under this Agreement, or use any Confidential Information to accomplish same, Contractor acknowledges that such party is responsible for a buyout fee payable to ATS.  Any action or inaction of Contractor that results in ATS not being paid the buyout fee, or that causes ATS to otherwise suffer loss or damage resulting therefrom, shall be paid and reimbursed by Contractor.  For the avoidance of doubt, if Contractor solicits employment or any other business relationship to or from any Health Care Provider, a company or agency that has contracted with ATS or any patient/client to whom Contractor has provided Services to under this Agreement, or uses any Confidential Information to accomplish same, then Contractor shall be liable to ATS for the buyout fee, or other loss or damages resulting therefrom. Contractor is an independent contractor of ATS and shall not be considered an employee of ATS. During the term of this Agreement and for a period of twelve (12) months thereafter, Contractor will not, directly or indirectly, solicit, hire or attempt to hire, use any Confidential Information to hire or attempt to hire, or assist any Health Care Provider, any company or agency that contracted with ATS or any patient/client to whom Contractor has provided Services to under this Agreement, any therapists (including independent contractors, employees, and subcontractors of ATS or any affiliate of ATS) from ATS or any affiliate of ATS, or otherwise solicit any of the foregoing persons or entities to leave ATS or to terminate their independent contractor, employee, business, or other relationships with ATS, for any  reason.  Contractor shall be liable at law or in equity to ATS for any breach of the provisions of this Section 21. 

Resignation: Should you decide to leave the Alpine Therapy Services, LLC team and no longer feel we are a good fit for you, please remember what is in the contract agreement as below. A written notice of at minimum 2 weeks for 1099 employees and 4 weeks for W2 employees, must be submitted to the HR department and CEO only to be accepted on a business day. Please note, the patients on your caseload are your responsibility. It is up to you to determine the best care plan for your patients during your departure transition period. Any patients needing additional care past your notice period, must be discussed with the CEO and HR department for transition planning purposes.  Additionally, all equipment must be returned on or before the last day of employment. 

• Termination of Contract. Termination of this agreement will be completed at time of resignation or as deemed appropriate by the CEO and HR department shall this agreement be breached. All team members must give a proper notification period of at minimum two (2) weeks as a 1099 contractor and four (4) weeks notice for all W2 therapists, with full responsibility to complete transition plans for all patients during resignation period. Written resignation notice shall be emailed to the Human Resource department and the CEO to include last day of planned employment. At that time, employee must submit all materials belonging to Alpine Therapy Services to include tablets, name badge and otherwise not listed, before or on the last day of employment, otherwise to be subject fines for the cost of each item.

• Permanent Placement to Agency. Should the contractor take a position with an agency contract with Alpine Therapy Services, LLC, the agency will be responsible for a TEN THOUSAND ($10,000) and/NO DOLLARS contractor buy out fee, with a 30 day notice. ATS contractors and any of its employees or subcontractors who provide services under the terms of this agreement are independent contractors of Alpine Therapy Services, LLC and shall not be considered employees of contracted AGENCY. During the term of this agreement and for a period of twelve (12) months thereafter, AGENCY will not, directly or indirectly, solicit, hire or attempt to hire any therapists (including employees, subcontractors of ATS or any affiliate of ATS) from ATS or any affiliate of ATS or otherwise solicit any such therapist of ATS, or any affiliate of ATS to leave ATS’s employment for any  reason. This prohibition shall be limited to a period of twelve (12) months from the earlier of the termination of the Agreement in writing and for twelve (12) months thereafter. In the event that Agency or any of its affiliates hires a therapists of ATS in violation of this paragraph, whether as an employee or subcontractor either directly or indirectly of AGENCY or its affiliate, or otherwise causes a therapist to leave employment with ATS, AGENCY shall pay ATS a FIFTEEN THOUSAND and/NO DOLLARS ($15,000) separation fee, which shall be due and payable in full upon the therapists separation of employment with ATS.

Main Number: 720-679-0020

Owner & CEO: Jayme Holcombe, DPT - jayme@alpinetherapyservices.com 720-679-0316

Operations Specialist: Paige Brown - operations@alpinetherapyservices.com 720-679-0313 (Direct Office number for calls and texts)

QA Consultant and IC Expert: Cory Molnar, DPT - cory@alpinetherapyservices.com 720-679-0020 ext 5.

Director of Business Development Sheri Mounteer -sheri@alpinetherapyservices.com

HR Specialist: Megan Phillips - hr@alpinetherapyservices.com 720-679-0020 ext 4

Team Experts

• Speech Language Pathology: Meghan Walton, SLP

  • meghanwalton524@gmail.com

  • 720-273-7605

• Occupational Therapy:

  • Sydney Schofield, OTR

    sydneyschofield1@gmail.com

    • 303-727-0595

  • Carmella Trejo, OTR carmellatrejoot@gmail.com

    • (303) 204-7872

• Physical Therapy:

  • Aaron Fyalka, DPT Aaron.fyalka@slu.edu

    • 217-891-3131

  • Aaron Vernon, DPT aaronandemily2012@gmail.com

    • (307) 757-7790

Start of Care (SOC) Scheduling: Must be completed in 48hrs of the order, or a delay order must be obtained (all delay orders must be written as a separate order BEFORE you evaluate, followed by another order AFTER you evaluate with your frequency and POC).

Documentation is due billed & signed within 48hrs of visit date.

• OASIS/Initial Evaluations
  Scheduling: Must be completed within the 5 day window of the SOC, or a delay order must be obtained
  Documentation is due billed & signed within 48hrs of visit date.

• Add-On Evaluations (evals added during an episode of care) - Must be completed within the 2 day window, or a delay order must be obtained

• Daily Visit Notes
  Scheduling: Must be completed weekly as written in frequency statement (ie: 1w3 = once a week for 3 weeks).
  Documentation is due billed & signed within 24hrs of visit date.

• Discharge w/ Visit is due billed & signed within 24hrs of visit date.

• Discharge w/out Visit is due billed & signed within 24hrs of visit date.

VO is required after every SOC or Evaluation for every discipline to continue skilled therapy services

VO’s must contain the following and must be written in an MD order or Evaluation section of the note under communication – other. This is a requirement to obtain prior to seeing the patient for follow up visits. 

• Date

• Time 

• Who you spoke too 

• Frequency and POC 

  Example – “VO from Mary, MA on 8/1/18 at 2:00pm for Dr. Smith to continue skilled PT 1w1, 2w3 for strength, balance and gait training.”

• VO for Delay of Eval/SOC - Can be combined with VO frequency order. Templates are available for verbiage under the orders section in Kinnser. An example: VO for delay of evaluation per patient request for scheduling, and POC approval for Skilled PT 1w1, 2w3 from Sarah Smith, RN for Dr. John on 7/1/26 @4:00pm.”

• VO for early DC - If a POC is not followed due to lack of insurance auth, or early DC per patient request, you must call the MD and obtain a VO for early DC. **TIP: You can call and leave a VM to notify the MD of early DC, but it needs to be written as “Dr Smith notified of early DC due to authorization on 7/1/26 @4:30pm.”

It is required we record vitals at EVERY patient visit.

The vital signs you need to take each visit include: Blood Pressure, Respiration, Heart Rate/Pulse, Oxygen (spO2), Temperature 

• B/P: Normal 180 / 20
  High: SBP>160 / DBP >90
  Low: SBP<90 / DBP <60 

• Respiration: Normal 12-20

  High: >28
  Low: <12 

• Pulse: Normal 60-100
  High: >120
  Low: <50   
  *Unless on Digoxin, then report <60 

• O2: Normal 88 - 100%
  High: no parameter
  Low: < 88%
  Normal: > 88% at high elevations (if they use O2, it is >88% with O2) 

• Blood Sugar:
  High: FSBS >200 / RBS >300 Low: FSBS <50 / BS <80 

• Temperature: Normal 97.8-99 F
  High: >101.5 F
  Low: <96 F
  

If you do not have your equipment with you or it is not working properly, you can still manually record respiration rate, and heart rate.

Vacation Coverage & Policy

The beautiful thing about a contract position, is that there are no set days for vacations per year. You can literally create your own schedule to take a week off at a time by planning ahead, inputting frequencies correctly and communicating with your patients and the ATS Team. You can take long weekends by planning ahead, or take a day off for appointments or to attend something important in your life (ex. Kindergarten graduations etc). Please remember your patients, are yours specifically; meaning it is your responsibility to plan ahead for their care plan.

Visits should be rescheduled during the certification period or another therapist can cover for you. SOLI will not allow more than one therapist assigned at one time. Therefore, once you have coverage plans, please notify management when patients can be transferred back and forth. 

Patient Vacations – If a patient is still considered homebound and gone for a week at a time for something that cannot be avoided, you can create a missed visit in advance using the Kinnser Order Template.

• Please make sure to ask patients their preferences before a holiday week. For example – you evaluate your patient at the beginning of November and feel they will need at least 8 weeks of therapy, you need to ask them what they want the week of Thanksgiving and Christmas ahead of time and plan your frequencies in advance. 

Tips & Tricks for scheduling around a planned vacation can be found under “Helpful Tools”. ATS Admin team is here to help you plan ahead for vacations, just ask!

Click here to view the 2026 Payroll Calendar

OASIS documentation is required to be completed by the first clinician in the home. It is a comprehensive list of questions and data which ensures agencies meet Medicare requirements.

OASIS GUIDELINES

OASIS GUIDANCE MANUAL

SOC GG Information

SOC M1800s Information

Section GG: Functional Abilities and Goals

Understanding OASIS M GG Coding

Start of Care OASIS:

Check SOLI to determine if the SOC has been completed, or needs to be done by you or another clinicians. RN, PT, and ST’s are primarily the clinicians who complete an SOC. In 2020, OTs were also able to do SOCs during the COVID pandemic. For documentation, please look at the protocol website and/or in the SOLI app. The SOLI app will tell you what agency you are representing, as well as the documentation type. 

SOC (Start of Care) marks the first day of the home health episode = 60 days. 

• Make sure you have SOC folder for that particular agency. If you do not have the appropriate folder, please contact the ATS task force (CEO, COO or CMO)

• Call patient to schedule- always say you're with the agency listed in SOLI. 

• Time Frame for scheduling SOC visit:  

  • SOC/ROC within 24 hrs if patient is discharged from an inpatient facility 

  • SOC/ROC within 48 hrs if patient is discharged from an outpatient facility 

NOTE: If you are unable to schedule the pt within this timeframe OR the visit needs to be replotted to the following Medicare week, please Notify the physician of the delay, complete a communication note, and complete an order stating reason for the delay, and that the Physician was notified and agreeable to the delay.

• Complete therapy visit – make sure to get patient signature in SOLI app, write down vitals in pt’s folder if available, write down next visit on pt’s calendar

Paperwork needed for SOC

• Fill-out and/or have Patient Sign the following forms (which may vary depending on Agency): Authorization for Service, Patient Triage/Risk Emergency/Disaster Evaluation or Patient Emergency Plan, Advance Directives form, Medical Insurance Benefits, and Medication List ***Please review the company protocol before completing the SOC paperwork

• White copy to office, yellow to patient if applicable

• Copies of SOC forms must be uploaded to the agency documentation system

• Home folder w/copies is given to patient.  Instruct how to call agency and State of CO for questions or complaints.

• Use of calendar for visit appointments is required in the state of CO – use the patients calendar or the calendar in the SOC book 

• Write down V/S every visit if Vital Sign sheet is available in the folder, must be documented in your notes as well

• Medication list is reconciled/coded

• Upon admission, if another discipline is indicated, but not included in the initial doctor’s order referral, pls call MD to get authorization and then add a physican order for the new discipline. ***Please review the agency protocol before completing an add on order.

After you have completed your visit:

• Call the MD for VO to continue (have your frequency, the patient info available to report to the MA/NP)

  • Frequency of visits for yourself (refer to the frequency tool guide and agency protocols)

  • Enter frequency into SOLI app

  • Disciplines needed. If you are requesting disciplines that are not ordered on the referral, it will be your responsibility to get the appropriate order(s) from the physician. 

  • If you are completing the SOC visitonly and another clinician will follow, please indicate this to the ATS Task Force. 

  • Please communicate to the agency with a synopsis of your POC and findings; location of this communication is listed on each company protocol.

NOTE: Visits on the ATS Kinnser will be added when frequency is approved for either documentation or billing, depending on the agency.

• Complete documentation within 48hrs

  • Complete OASIS with Medication Reconciliation

  • Run OASIS check/ correct any errors

  • Go by cert dates in the documentation system – if you notice it is different than SOLI, notify the office

• Scan SOC paperwork and upload to the documentation system

• Upload HEP  to the agency documentation system 

• Schedule with patient once VO has been received and POC has been approved. 

Re-Cert/ROC OASIS:

MAKE SURE TO DOCUMENT AND EMPHASIZE SKILLED NEED DURING RE-CERT!! Please make sure the agency is in agreement with recert per the company protocols. 

Time Frame for planning Re-Certification:  

• If you know you want to Re-Cert a patient, please do the following 2 WEEKS or more before your re-cert visit

• Call physician’s office for verbal orders – make sure to take note of who you talked to, date, and time

• Required: Call Agency to discuss your plan

  • If the agency approves: Enter a new ORDER (in the agency documentation system) – utilizing the Template: RECERT ORDER or ROC ORDER. Fill out the form completely

• Re-cert vists and re-evaluations must be completed within the last 5 day window of the end of the cert period. Questions, please ask the ATS Task Force. 

Time Frame for scheduling ROC visit:  

• ROC within 24 hrs if patient is discharged from an inpatient facility 

• ROC within 48 hrs if patient is discharged from an outpatient facility 

NOTE: If you are unable to schedule the pt within this timeframe OR the visit needs to be replotted to the following Medicare week, please Notify the physician of the delay, complete a communication note, and complete an order stating reason for the delay, and that the Physician was notified and agreeable to the delay.

Discharge OASIS

• ALWAYS check who should be doing the DC OASIS – it is always the last clinician seeing the patient. Please review each company protocol before completing a DC OASIS. 

• HEP for every patient – upload to the agency documentation system at Discharge for discharge instruction rules and regulations. 

• Notice of Medicare non-coverage (NOMNC)  form- SHOULD BE DATED 48 HOURS BEFORE DC and must be uploaded with DC OASIS 

• Run the OASIS check to ensure all questions are answered, any corrections are completed before final submission. 

• Timeline to complete DC OASIS = 24hrs. 

Therapy Evaluation (NON-OASIS EVALS)

MAKE SURE SN/PT SOC VISIT HAS BEEN COMPLETED BEFORE GOING OUT TO SEE THE PATIENT

Steps:

1. Call to schedule patient. Always say you're with the agency! Agency is listed in SOLI on patient chart.

   Timeframe for scheduling SOC visit:  Initial Eval within 5 days after SOC/ ROC / Re-cert for all secondary disciplines 

   NOTE: If you are unable to schedule the pt within the 5 day window OR the visit needs to be replotted to the following Medicare week, notify the physician of the delay, complete a communication note, and complete an order stating reason for the delay, and that the Physician was notified and agreeable to the delay.

2. Complete therapy visit – make sure to get patient signature in SOLI app, write down vitals in pt’s folder if available, write down next visit on pt’s calendar

3. Call physician’s office for verbal orders – make sure to take note of who you talked to, date, and time; you must have a VO before returning to the patient after evaluation is complete. 

4. Enter a communication note with every attempt made in communicating/scheduling with the patient 

5. Enter frequency into SOLI app. Visits in ATS Kinnser will be plotted when frequency is approved.

6. Complete documentation within 24hrs. 

Therapy Re-Evaluation (NON-OASIS EVALS)

MAKE SURE TO DOCUMENT AND EMPHASIZE SKILLED NEED DURING RE-EVALUATION! Make sure you are showing skilled need and changes (progression/regression) each visit and your documentation includes the following:

1. A written statement regarding the comparison of current measurements to previous measurements (just listing current measurements is not enough) 

2. A written statement regarding the therapist’s determination of the effectiveness of therapy or lack thereof. 

Without these two statements the re-evaluation is considered incomplete and will be denied along with all visits made after the re-evaluation

Please review each company protocol for re-evaluation guidelines. Per the general rules and regulations for Colorado, a patient must be re-evaluated at least once every 30 days. 

NOTE: If you know you want to change your discharge visit to a Re-evaluation visit, please do the following 1 week or more prior to re-evaluation visit to make sure your visit type is changed.

• Call physician’s office for verbal orders – make sure to take note of who you talked to, date, and time

• Enter a new ORDER  – utilize the following template:

  • “Request to change D/C visit to Re-Evaluation and request to continue [discipline] intervention at [frequency] effective [date] to address [deficits]. Verbal Orders received from [name, title] at [MD name] office at [time, date].

If you are unable to schedule the pt for re-evaluation within the 30 day window, please call the agency to discuss possible nonbillable DC. If the re-evaluation is within the 30 days, and needs to be replotted to the following Medicare week, call physician for verbal orders to cover your additional visit, complete a communication note, and complete an order for 1w1 (for example) to cover re-evaluation visit stating reason and Physician was agreeable to the delay. 

Go by cert dates in the documentation system – if you notice it is different than SOLI, notify the office

A printable Evaluation Checklist is available under “Helpful Tools”

Evaluative assessments are available under “Helpful Tools”.

Daily notes are documented after a skilled visit has been completed.

Definition of a Skilled Visit: at minimum 30 minutes of face to face skilled care with a patient. Documentation time should be added to your total time (i.e. Face to Face with the patient 30mins and document for 15mins = 45mins total).

A Daily Notes visit requires the following information:

• Time In & Time Out

• Date

• Confirmed patient identity (check off)

• Vitals

• Pain Levels

• Subjective Evaluation

• Objective Evaluation

• Teaching (check applicable boxes)

• Progress to Goals

• Intervention/Education provided

• Plan (must always check “discharge planning”)

• Sign & Date

DON’T FORGET Patient Signature in SOLI !

A printable Daily Notes Checklist is available under “Helpful Tools”.

Discharge with Visit

• ALWAYS check who will be the last out and who is responsible for DC OASIS!!

• Please review company protocols before completing the Discharge Visit for specifics. 

• Notice of Medicare non-coverage (NOMNC) form- SHOULD BE DATED 48 HOURS BEFORE DC and must be uploaded to the agency documentation system. Typically the therapist who completes the DC OASIS is the one who will upload the NOMNC. 

• HEP for every patient must be uploaded into the documentation system 

• Vitals are required at each visit, including the Discharge visit

• Goals must be reviewed at Discharge visit

• If an assistant treated the patient during the cert period, please also include a supervisory visit to the Discharge visit for compliance.

Non-Visit Discharge:

• A discharge without a visit or a “Non-Visit Discharge” is either done by a Nonbillable Discharge OASIS if you are the last clinician in, or “Discharge Summary” if you are discharging your discipline per patient request, due to authorization, etc.

Missed visits occur for a myriad of reasons and are sometimes unavoidable, such as if you arrive at the patients home and they are not there, or do not answer the door. Before entering a missed visit please try and reschedule your visit for later in the week or consider changing your POC to avoid entering a missed visit. If you update your POC and physician order and VO are required. 

Initial Evaluations or SOC cannot be marked as “Missed Visits”.

ATS does not provide any payment or reimbursement for no show visits, but some agencies do! Check the important notes in SOLI for each agency or contact the ATS Admin team for clarification.

Read more tips on how to handle attendance, late cancels and no-shows under “Helpful Tools”.

Communication Notes must be entered in Alpine Kinnser for the following purposes:

• Scheduling attempts, i.e. ‘left VM for the patient on 7/1/26, 7/2/26 waiting for call back to schedule.

• Spoke to Agency about patient concerns related to add on MSW needs.

• Anytime you communicate between other disciplines, the patient or patient family members, document it as a comm note, otherwise ‘it never happened.’

Medical Orders for Scope of Treatment (MOST) is a form in home health that is used when caring for patients with serious, life-limiting illnesses or advanced frailty. Usually the Home Health Agency will complete this form. If it is needed, a copy is linked below.

Colorado MOST Form

In an effort to reduce the risk for infection in clients and staff members, thorough hand washing/hand antisepsis is required of all employees. The agency will establish guidelines for all staff and will provide education and direction on accepted practices.

PURPOSE

To improve hand-hygiene practices of agency staff and to reduce transmission of pathogenic microorganisms to clients and personnel in the home care setting.

SPECIAL INSTRUCTIONS

1. The hand hygiene procedure will be clearly outlined in the agency procedure
   manual. 

2. Appropriate antiseptic cleanser may be used when appropriate and client situation facilities are not available.

3. Indications for hand washing and hand antisepsis:

   1. Before performing invasive procedures.

   2. Before caring for clients at high-risk for infection.

   3. When there is prolonged or intense contact with the client (bathing the client).

   4. Between tasks on the same client.

   5. Before touching a wound.

   6. After removing gloves.

   7. After touching objects that are potentially contaminated. 

   8. After caring for a client who is infected with drug resistant organisms.

   9. When hands are visibly soiled.

   10. After using the toilet, blowing the nose or covering a sneeze.

   11. After assisting client to use the bathroom.

   12. Before eating, drinking, handling food or serving food.

   13. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap with water.

   14. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations. Alternatively, wash hands with antimicrobial soap and water in all clinical situations.

   15. Decontaminate hands before having direct contact with clients, before donning sterile gloves to insert urinary catheters, vascular catheters or other invasive devices that do not require surgical procedures.

   16. Decontaminate hands after contact with client’s intact skin, after contact with body fluids, excretions, non intact skin and wound dressings.

   17. Decontaminate hands after contact with inanimate objects including equipment in the immediate vicinity of the client.

   18. Decontaminate hands after removing gloves.

4. WASH HANDS with soap and water before eating and after using a restroom.

5. Antimicrobial impregnated wipes (towelettes) may be used as an alternative to washing hands with non-antimicrobial soap and water. They are not as effective as alcohol based hand rubs or washing hands with antimicrobial soap and water.

6. Health care personnel should avoid wearing artificial nails and keep natural nails less than one quarter of an inch long if they care for clients at high risk of acquiring infections.

HAND HYGIENE TECHNIQUE

1. When decontaminating hands with an alcohol based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. (Follow manufacturers recommendations regarding volume of product to use.)

2. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by manufacturer to hands and rub hands together vigorously for at least fifteen (15) seconds, covering all surfaces of hand and fingers. 

   1. Rinse hands with water and dry thoroughly with a disposable towel. (Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis.) 

   2. Encourage the use of hand lotions or creams to minimize the occurrence of irritant contact dermatitis associated with hand antisepsis or handwashing.

3. Multiple use cloth towels are not recommended for use in health care settings.

Hand Washing Video: https://www.youtube.com/watch?v=IisgnbMfKvI

https://www.medicare.gov/coverage/home-health-services

ATS INFECTION CONTROL MEASURES IN YOUR CAR: 

What is it?  A detailed plan to keep you and your patients safe and germ free, ALWAYS. To also follow CMS guidelines for infection control. 

Where can I find it? (BELOW)

• ITEMS recommended for your car: Trash bag or large ziplocks (clean and dirty bags) for items you doff at your car and not inside the patient home. Inside the patient home, it is recommended to dispose trash in their trashcan as it is cross contamination to bring trash to your car from the patient home. 

  • Large plastic bins with lids for infection control purposes and HIPAA protection to consist of HEP, SOC books, paperwork, extra supplies, PPE and a bin for your bag unless you have rubber mats and a roller bag. 

• Car Technique: Clean & dirty areas that are wipeable  (i.e. a plastic tub with HEP, SOC books, protocols and clean medical supplies separated from paper products AND a plastic tub to place your bag). If you have rubber mats and a rolling bag, you can place your bag on the rubber mat as it is wipeable and the bottom surface of your bag is not touching the surface of your car)

  • Recommended for patients: when you get to your car, remove all PPE to include gloves first, place in ‘dirty’ ziplock, use hand sanitizer and then doff your mask and eye wear – spray eye wear and mask with Lysol or hydrogen peroxide and place in a ‘clean’ ziplock. 

    • Please pay attention to droplet precautions vs airborne precautions for infection control measures

What to watch for:

• Conceal all HIPAA information in a covered notebook, calendar etc. (i.e. make sure a bystander can’t see patient information by looking in your car). 

• PLEASE limit HIPAA information in your car in the event that your car is stolen!!!!! This would be a breach of HIPAA and is still considered the fault of the car owner and not the thief that stole your car. 

• Infection control is imperative for your car to prevent cross contamination between patients, or between your patients and your home. 

ATS INFECTION CONTROL MEASURES BEFORE/DURING/AFTER TREATING A PATIENT: 

What is it?  A detailed plan to keep you and your patients safe and germ free, as well as to prevent cross contamination.

Where can I find it? (BELOW)

• WHAT TO WEAR: Pay attention to airborne precautions vs contact, universal, or droplet precautions and dress accordingly. Consider wearing scrubs, shoes that can be wiped down, gloves and disposable or reusable N95 masks, as well as protective eyewear for airborne and droplet precautions. Universal Precautions will be used primarily for the majority of your patients. 

  • BEFORE: Read patients PMH to ensure you have the correct materials for PPE. 

  • DURING: When in your car, have hand sanitizer available. Use trunk/car technique and bag technique!!! Wash your hands after treatment.

  • AFTER: After leaving the patient home, if you don’t doff gloves in patient home - doff gloves first and place in your car trash bag, sanitize your hands and then doff eyewear (clean and store in clean region of your car trunk). Clean hands with sanitizer in the trunk of your car, follow car infection control tech. If you are wearing a mask,  sanitize your hands then pull mask down between visits or take off, spray with Lysol or hydrogen peroxide and place in a clean ziplock.

    • Once home at the end of your day, we recommend you wipe down or spray your front seat of your car, steering wheel and steering controllers; then take off your scrubs and shoes immediately before or just after entering your home. WASH your scrubs immediately, as well as disinfect the reusable N95 mask or an original N95 mask. WIPEDOWN your shoes immediately and spray with Lysol if available. SHOWER ASAP to ensure you prevent germs in your home. 

  • GENERAL: 

    • AVOID touching your eyes, nose, and mouth 

    • AVOID close contact (less than 6ft) with people who are sick

    • Stay home if you’re sick

    • Cover your cough/sneeze with a tissue or into your arm sleeve. 

    • Clean and disinfect frequently touched objects such as your phone, computer, ipad, stethoscopes, pulse ox, thermometer etc. 

• BAG TECHhttps://www.youtube.com/watch?v=Hhi-o5IgKDk - bag technique (always use a bag barrier disposable or reusable, or a rolling bag for every visit). Consider only taking in necessary items in a smaller bag such as a ziplock, rather than your entire bag. If the patient is not a cardiac patient or not on O2 for respiratory conditions, you can ask the patient if they’d like their vitals taken, if not simply document ‘patient refused vitals at this visit.’ This will help save your PPE. 

• HANDWASHINGhttps://www.youtube.com/watch?v=3PmVJQUCm4E – This is the BEST way to protect yourself and others. It is recommended to handwash before and after treating  a patient, or after three uses of hand sanitizer (be sure to use your own paper towels and never shake your hands or flick water before drying); wash your hand with soap and water for at least 20sec, wash between fingers, tops of hands, fingernails, wrists. If soap and water is unavailable, use sanitizing gel (95% alcohol) and rub hands together until dry. 

• DONNING/DOFFING TIPS FOR PPEhttps://www.youtube.com/watch?v=oxdaSeq4EVU PPE must be donned and doffed in a specific order to ensure you are not breaching your safety or the safety of the patient (i.e. donn mask before gloves, and remove gloves before removing mask; wash hands after removing gloves). A gown or goggles are not required unless the patient is on droplet precautions (not typically seen in the home health setting). 

What to watch for: Constantly monitor your PPE supply and order supplies in advance to prevent running out. Please reach out to the ATS TASK FORCE if you need additional supplies if you get in a bind. We have reusable N95 masks, as well as original N95 masks that have been made out of 100% cotton in three layers per the CDC recommendations. 

BED BUGS

Wear clothing that can be washed then dried in a hot dryer. 

• Light colored clothing makes it easier to see bed bugs. Choose pants without cuffs and shoes that are smooth with no trim that bed bugs can hide underneath.

• Be careful where you sit. The safest choice is a hard kitchen chair. Try not to sit on sofas and beds.

• Equipment

• Take in the least amount of stuff possible. Things like bags, tool kits, and coats are good hiding places for bed bugs.

• Put a barrier under your bag or other equipment to isolate it from the room. A white plastic bag works well as a barrier. Bed bugs are not likely to crawl on it because it’s smooth. Using a plastic bag that is white makes bed bugs easier to see. Leave whatever you use as a barrier under your bag for the client to throw out.

• Going Home after Work

• When you work in places that have, or may have bed bugs your biggest fear is bringing them home with you. Having a routine that will kill a bed bug that manages to hide on your equipment or clothing is a good way to stop this happening.

• Take off the clothes you were wearing in the bed bug infested building as soon as possible and before moving around in your home. A great place is a garage if you have one.

• If you don’t have a garage, take off any clothing that may be infested with bed bugs as close to the entrance door as possible. If you live in an apartment, the bathtub might be the best place. This is because bed bugs are easy to see on light surfaces and don’t like crawling on smooth slippery surfaces. 

• Put all your clothing in a plastic bag.

• Seal the bag and take it directly to the washing machine.

• If your clothes are still clean, put the clothes in a dryer on the hottest setting for 30 minutes. It is the heat of the hot dryer that kills the bed bugs.

• Don’t take clothes off in your bedroom.

• Working with Clients Living with a Bed Bug Infestation

If your client lives in a home he or she (or their family) own they should call a pest control company for help to treat the bed bug infestation.

If you work in different homes during the day, be very careful not to transfer the bed bugs from one place to the other. If you know a place has bed bugs, visit it last. You can also wear a protective coverall so the bed bugs can’t crawl under a seam or in a pant cuff.

STANDARD PRECAUTIONS FOR ALL HEALTH CARE WORKERS

1. Assume that blood and all body fluids, with or without visible blood, from all clients are potentially infectious.

2. WASH HANDS - SEE HAND HYGIENE POLICY.

3. GLOVES, such as vinyl or latex medical gloves, must be worn when cleaning reusable equipment; when having direct contact with blood, body fluids, mucous membranes or non-intact skin; when handling items soiled with blood; or when handling equipment contaminated with blood or body fluids. This includes, but is not limited to the following:

   1. Suctioning procedures.

   2. Catheter care and removal of catheters.

   3. Dressing changes.

   4. Handling of grossly contaminated linens.

   5. Collection and emptying of all suction and drainage devices; e.g., Foley catheter bags, suction machines, and hemovacs.

   6. Starting and discontinuing intravenous infusions.

   7. Providing oral hygiene.

   8. Enema administration.

   9. Cleaning client rooms, bathrooms, emptying trash, or changing linens on client’s bed.

   10. Venipuncture or other vascular access procedures.

4. Gloves should be changed after each client contact. When gloves are removed, thorough hand washing is required. Gloves do not take the place of hand washing.
   If glove is torn or needle stick or other injury occurs, the gloves should be removed, hands washed well, and a new glove used as promptly as client safety permits.

5. GOGGLES or protective glasses should be worn when there is a potential for a splash with blood or body fluids, and when exposure of the mucous membranes of the mouth, nose, or eyes is anticipated. Examples include dental cleaning, venipunctures, arterial punctures, catheter or nasogastric tube insertions, and intubations. Protective eyewear is to have solid side shields.

GOWNS OR APRONS should be worn when there is a potential for blood or body fluid splatters or sprays. Examples include venipunctures, arterial punctures, catheter or nasogastric tube insertions, and intubations.

MASKS are usually not necessary if contact is only casual. A mask should be worn if there is a chance of a splash or splatters or if the client is on respiratory precautions.

AIRWAYS - Although saliva has not been implicated in HIV transmission, a one-way airway, mouthpiece, resuscitation bag, or other ventilation device should be in the home when resuscitation is predictable for use during actual resuscitation.

To prevent needle stick injuries, needles should never be recapped, bent, broken, or manipulated by hand. These items and other sharp items, such as scalpels, razor blades, etc., should be considered potentially infectious and handled with extraordinary care.

1. Agency will provide “needleless systems” or “sharps with engineered sharps injury protections whenever possible. Used needles should be placed intact into puncture-resistant containers that are provided by the agency.

2. Employees responsible for client care will be involved in decisions to purchase sharps, needleless devices, disposal containers and biosafety cabinets. 

3. The containers, when full, are to be returned to the agency for proper disposal or disposed of in accordance with state or local regulations.

In the event of contamination with blood or body fluids, body surfaces should be washed immediately with soap and water.

The agency will maintain a log of injuries from contaminated sharps. The injury log must contain: type/brand of device involved, department or work area, and explanation of the event. Maintain a separate list for tracking actual employees. 

All needle stick injuries will be recorded on an OSHA log.

Identify “privacy concern case.”

The agency will document their consideration and implementation of safer, effective medical devices. 14. All laboratory specimens should be treated as if they were contaminated with either HIV or HBV or Hepatitis C. All specimens should be labeled with client information, placed in sealable, leak proof plastic bags, and transported in an appropriate, secured container that is labeled with a color-coded, biohazard sticker. Specimens should be transported without needles attached to syringes. Requisition forms are placed outside the plastic bag to prevent contamination in the event of a leak or spill.

1. For disposal of contaminated supplies other than needles, double bagging technique should be used, as described in the infection control policy. Areas and equipment contaminated with blood should be cleaned immediately with 1:10 bleach solution (1 part bleach to 10 parts water. Equipment can also be cleaned thoroughly and soaked in 70% isopropyl alcohol for ten (10) minutes to inactivate HIV. A fresh solution must be used daily. A 1:5 bleach solution (1 part bleach and 4 parts water) can be stored for thirty (30) days in an opaque container at room temperature and out of sunlight. Bleach should never be mixed with anything but fresh tap water. Contaminated reusable sharps should be placed in a leak-proof, puncture-resistant, and appropriately labeled container.

2. Soiled linens should be handled as little as possible and with minimum agitation to prevent gross microbial contamination of the air and of persons handling the linen. Linens soiled with blood or body fluids should be placed in bags that prevent leakage and transported to the agency or disposal container. If the fabric can tolerate contact with chlorine bleach, it should be washed with one (1) cup of bleach per full load with regular detergent. If a washing machine is not available, contaminated linens should be soaked in a receptacle or sink in cold soapy water in a 1:10 bleach solution for fifteen (15) minutes.

3. Personnel cleaning biological spills or contaminated equipment should wear gloves and take care not to contaminate clothing. Disinfectant-detergent formulations registered by the EPA can be used for cleaning environmental surfaces, but the actual physical removal of microorganisms by scrubbing is probably at least as important as any antimicrobial effect of the cleaning agent used.

4. Health care workers with exudative lesions or weeping dermatitis should refrain from all direct client care and from handling client care equipment until the condition resolves.

5. As indicated, the agency shall maintain a log describing the collection, transportation, and disposal of hazardous waste.

A 485 by definition is “ Home Health Care Agency to serve as a plan of care and certification or recertification in case the physician assumes oversight of patient care” 

A 485 consists of the SOC medications, functional status, evaluation verbiage, goals and frequency noted at SOC, as well as the evaluation findings for all disciplines involved. 

This is why it is imperative that all evaluations are completed within the 5 day window, in order to complete the 485 per the rules and regulations for home health!!!!!

The overseeing physician will sign and return the 485 in agreement with the POC.