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HOME HEALTH . THERAPY . PRIVATE DUTY . HOSPICE

Kinnser is software for better post-acute care.

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Today’s educational presentation is provided by

The software that powers… HOME HEALTH . THERAPY . PRIVATE DUTY . HOSPICE

877.399.6538 | sales@kinnser.com | www.kinnser.com

About the presenter JILL DYER BSN, RN, HCS-D, HCS-O Home Health Executive, Consultant J.I.D. Consulting

About the presenter

SHARON HARDER President C3 Advisors, LLC

More info: c3advisors.com

Today’sFocus! Pa1entRights

! Representa1ves! No1ces! ExerciseofRights! InvolvementinCareandCarePlanning! TransfersandDischarges

! Complaints–Documenta1on,Inves1ga1onandResolu1ons

! OASIS–PrivacyandDataSubmission

BreakingNews–Interpre=veGuidance! DraAInterpre=veGuidancewereissuedonOctober27th

! AvailableathFp://report.nahc.org/wp-content/uploads/2017/10/3819-F-HomeHealthAgency-CoPs_IGs.pdf

! CMSwillnotentertainindividualcomments,butwillacceptcommentsfromNAHC

! CommentsforNAHC’sconsidera1onshouldbesubmiFedtoMaryCarratmkc@nahc.org

! Today’sslidesmarkedwithshowthemostrecentdraZinterpre1veguidance

KeyDefini=on–Pa=entRepresenta=ve! Pa1ent’slegalrepresenta1veorapa1ent-selectedrepresenta1vewhopar1cipatesincaredecisions

! Canbeafamilymemberorotherpa1entadvocate

! Thepa1entdeterminestherepresenta1ve’sroletotheextentpossible

! Representa1ve’srolebasedonthepa1ent’sstatedpreferenceshouldbedocumentedintherecord

KeyDefini=on–Inadvance

! Meansthattheagency’sstaffmustcompletethetaskpriortoperforminganyhands-oncareorpa1enteduca1on

! Willbeakeydefini1onduringsurveysandmedicalreview

Pa=entRights

“Thepa1entandrepresenta1ve(ifany)havetherighttobeinformedofthepa1ent’srightsinalanguageandmannertheindividualunderstands.TheHHAmustprotectandpromotetheexerciseoftheserights.”

§484.50–Pa=entRightsa)  No1ceofrightsb)  Exerciseofrightsc)  Rightsofthepa1entd)  Transferanddischargee)  Inves1ga1onofcomplaints

f)  Accessibility

§484.50(a)-No=ceofRights! Pa1entandhis/herrepresenta1vemustreceivethefollowinginwri1ngbeforecareisprovided:

! No1ceofPa1entRightsandResponsibili1es!  Informa1onconcerningtheagency’stransferanddischargepolicies! Contactinforma1onfortheAdministrator! OASISPrivacyNo1ce

! TheNo1cemustbesignedbythepa1entand/orthelegalrepresenta1veandmaintainedinthepa1ent’srecord

WriUenNo=ceofPa=entRights! Ifthepa1ent’srepresenta1veisnotlegallyappointedviaaguardianship,POAorotherlegalinstrument,informa1onmustbeprovideddirectlytothepa1ent

! Ifthepa1enthasalegallydesignatedrepresenta1ve,thewriFenno1cemustbeprovidedpriortoini1a1ngcare,butthereisoneavailableexcep1ontothe1mingofno1cefortherepresenta1ve

! Ifthepa1entdeclinesno1cetohis/herrepresenta1ve,theagencyshoulddocumentthedeclina1oninthepa1ent’srecord

! Theformthatisusedshouldcontainaconfirma1onstatementthattheNo1ceofPa1entRightshasbeenreceivedbythesigner(s)

LegalRepresenta=veExcep=on! Ifthepa1ent’slegalrepresenta1veisnotavailableandthepa1enthasnotdeclinedtohavetherepresenta1veinformedastopa1entrightsandresponsibili1es,

! TheagencymayprovidethewriFendocumenta1ontothepa1entrepresenta1vewithinfourdaysofini1a1ngcare

! Informa1oncanbeprovidedtotherepresenta1veelectronicallyorinwriFenformthroughthemail

AdministratorContactInfo! Administratorinforma1onisforthepurposeofenablingthepa1entorhis/herrepresenta1vetolodgeacomplaint

! ViewedbyCMSasanessen1alfunc1onofleadership

! Name,businessaddressandbusinessphonenumberoftheadministratorarerequiredasapartoftheno1ceofrights

OASISPrivacyNo=ce! Mustbeinaddi1ontootherrequiredno1cessuchasHIPAAprivacy

! Thisno1ceshouldbeapartoftheoverallPa1entRightsNo1ceandmustbeprovidedanddocumentedattheini1alassessmentvisit

! Appliestoallpa1entsforwhomOASISdataisgathered

VerbalNo=ceofPa=entRights! Verbalno1ceofpa1entrightsandresponsibili1esmustalsobeprovidedintheindividual’sprimaryorpreferredlanguage,

! And,inamannerthattheindividualunderstands

! Ifaninterpreterisneededtofulfillthisrequirement,theservicemustbeofferedwithoutchargetothepa1ent

! Verbalno1cemustbedeliverednolaterthanthesecondvisit

Extenua=ngCircumstances! CMSacknowledgesthatthereare1meswhenitmaybedifficulttofindaninterpreterforlesscommonlanguages

! CMSexpectsthattheagencywillexhaustallavenuesincludingtelephonictransla1onservices,videoconferencingoronlinetransla1onofwriFendocuments

! Suchop1onsareacceptableaslongastheymeetthepa1ent’sneeds

Interpre=veGuidance–Pa=entNo=ces! Expectedthatanagency’spa1entswillbeabletoconfirmduringasurveypa1entvisitorotherinterviewthat:

! Theirrightsandresponsibili1es,and

! Thetransferanddischargepoliciesoftheagencywereprovided,

! Inalanguagethatthepa1entunderstood,and

! Inamannerthataccommodatedanydisabilitythepa1entmighthave

Interpre=veGuidance–Pa=entNo=ces! Shouldbeahardcopyunlessthepa1entrequestsanelectronicno1ce

! Ifthepa1ent’sunderstandingofEnglishislimited,theinforma1onmustbeprovidedinalanguageorformatfamiliartothepa1entorhis/herrepresenta1ve

! Useofbilingualstaff,interpreters,formalarrangementswithlocalorganiza1onsthatprovidetransla1onservicesortelephonicinterpreta1onforlanguageassistance

! Agencystaffshouldbetrainedtoiden1fypa1entswithlanguagebarriersandstaffwhohaveongoingcontactwithpa1entsshouldbetrainedineffec1vecommunica1ontechniquesincludingtheuseofaninterpreter

Interpre=veGuidance-Transla=on! Ifthepa1entspeaksalanguagethathasnotbeentranslatedbytheagencyintoitswriFenpa1entrightsmaterials,theagencycandelaytheno1fica1onofpa1entrightsandresponsibili1esun1laninterpreterispresenttotranslate

! ThepermiFeddelayonlyextendstothesecondvisit

! Agencyshoulddocumentthattheverbaldiscussionofrightstookplaceandthatthepa1entorhis/herrepresenta1vewasabletoconfirmunderstandingoftheconversa1on

§484.50(b)-ExerciseofRights! Ifthereislackof“legalcapacity”basedonacourtdecisionorprovisionofstatelaw,

! Rightsofthepa1entmaybeexercisedbythepersonappointedbythecourttoactonthepa1ent’sbehalf

! Intheabsenceofacourtappointedrepresenta1ve,thepa1ent’srepresenta1vemayexercisethepa1ent’srights

! Ifthereisacourtorderastothepa1ent’slegalcapacity,thepa1entmayexercisehis/herrightstotheextentallowedbythecourtorder

Interpre=veGuidance–ExerciseofRights

! Theagencyshouldhavedocumenta1onofanyadjudica1onbyacourtwhichindicatesthatapa1entlackscapacitytomakehealthdecisions

! Thedocumenta1onshouldincludethename(s)ofthosewhohavebeeniden1fiedbythecourttoexercisethepa1ent’srights

! Theagencyshouldhavespecificpoliciesandproceduresinplacetodirecthowdocumenta1onoflegalcapacityisincludedinthepa1entrecord

§454.50(c)–Rightsofthepa=ent1.  Tohavehis/herpropertytreatedwithrespect2.  Tobefreefromverbal,mental,sexualandphysicalabuseincludinginjuries

ofunknownsource,neglectandmisappropria1onofproperty

3.  Tomakecomplaintstotheagencyregardingtreatmentorcare

4.  Topar1cipateinandbeinformedaboutandconsentorrefusecareinadvanceoftreatment

5.  ToreceiveservicesoutlinedinthePOC6.  Tohaveaconfiden1alclinicalrecordandaccesstothatrecord

§484.50(c)–Rightsofthepa=ent7.  TobeadvisedoftheextenttowhichpaymentmaybeexpectedfromMedicare,

Medicaidoranyotherfederallyfundedprogram

8.  ToreceiveproperwriFenno1ce,inadvanceofachangeordiscon1nua1onofservice

9.  Tobeadvisedofthestatetollfreehomehealthhotlineandcontactinforma1on

10. Tobeadvisedofthecontactinforma1onforfederalandstateen11esthatservethepa1ent’sarea

11. Tobefreefromdiscrimina1onorreprisalforexercisinghis/herrighttovoicegrievances

12. Tobeinformedoftherighttoaccessauxiliaryaidsandlanguageservices

Interpre=veGuidance–RespectforPropertyandPerson

! Policyandstafftrainingfocusedonensuringthatpa1entpropertyisrespectedbothinsideandoutsidethehome

! Policyfocusedonagencyconsidera1onofpa1entrequestswithintheparametersoftheassessmentandplanofcare

! Pa1enttreatedasanac1vepar1cipantinthedeliveryofcare! Pa1entisinformedofthevisitscheduleandchangestotheschedule

! Visitsshouldbeonaschedulethatisconvenienttothepa1entandnotnecessarilytheagency’sstaff

Interpre=veGuidance–Abuse,InjuriesandNeglect

! Pa1enthasarighttobefreefromabusefromtheagencystaffandothers!  VerbalabuseincludingwriFenorgesturedlanguage! Mentalabuseincludingthreats,humilia1onorthreats!  Sexualabuse!  Physicalabuseincludingcorporalpunishmentandrestric1veorintrusiveprocedurestocontrolbehavior

! Misappropria1onofproperty–theZfromthepa1entorhis/herhome

! Policiesandproceduresshouldbeinplacetoestablishtheagency’smethodsforensuringrespectforpa1entsandtheirpropertyandhandlingpa1entcomplaintsorotherallega1onsofimproperconduct

InjuriesofUnknownSource! Notwitnessedandpa1entcannotexplaintheinjury! Agencyshouldcarefullydocumentandmonitorthesitua1on

! Allega1onsorevidenceofabusemaywarrantachangeintheplanofcareand/orreferraltoanappropriateagencyforfollowup

! Agencymustinterveneimmediatelyasindicatedbythecircumstancesifaninjuryistheresultofanemployeeac1onandstaffmustberemoved

! Agenciesmustbeabletodemonstrateknowledgeofapplicablestatelaw

Interpre=veGuidance–FilingComplaints! AgencyshouldhavewriFenpoliciesfor:

! Acceptanceofcomplaints! Processingofcomplaints! Reviewprocedures! Resolu1onprocess

! Policiesshouldinclude1meframesforconduc1ngtheinves1ga1on,documenta1onofoutcomesandac1onstobetaken

! Thepa1ent’srecordandhomefoldershouldconfirmthatinforma1onregardingthepa1ent’srighttolodgeacomplaintwasprovided

Interpre=veGuidance–Par=cipa=onandConsent

! Pa1entmustbegivenop1onsregardingcarechoicesandpreferences

! Informedconsentisnotintendedtobethefunc1onofaform

! Informedconsentisongoingascarechangesandevolves

! Allaspectsofcareandservicesandthemannerservicesaretobedeliveredareafunc1onofpar1cipa1onandconsent

! Theremustbeevidenceintherecordthatthepa1entwasconsultedandthathe/sheconsentedtoplannedservicesandcare

! ChangesinthePOCmustbecommunicatedtothepa1entnolaterthanthevisitthatmostcloselyfollowsthechange

! Agencymustdocumentthatthepa1entwasinformedofthechange

MoreonPar=cipa=onandConsent! Extendstocomple1onofassessments

! Disciplinesthatwillfurnishserviceandvisitfrequencies

! Expectedoutcomesofcareincludingpa1ent-iden1fiedtreatmentgoalsandbenefits

! Anyfactorsthatcouldimpacttreatmenteffec1veness

Interpre=veGuidance–ServicesinthePOC! Thepa1entisen1tledtoreceivealloftheservicesandtreatmentsoutlinedinthePlanofCare

! ChangemayberequiredinthewayPOCsaresetforthwithtasksselectedbyassessingclinicians

! MakesurethatthePOCincludesonlythosetasksandtreatments/assessmentsthatarereallyneededbythepa1ent

! IfataskisincludedinthePlanofCare,surveyorsandreviewersaregoingtolookfordocumenta1onthattheservicewasperformed

Interpre=veGuidance–ServicesinthePOC! CMShasclarifiedthatthePlanofCareandamendmentsdonothavetobeprovidedtothepa1entandrepresenta1ve

! But,otherdocumenta1onmustbeprovidedwithin5daysoftheini1alassessment

1.Visitschedulewithfrequencyofvisitsbydiscipline2.  Medica1onscheduleandinstruc1ons3.  Treatmentsthatwillbeadministered4.  Per1nentinstruc1onsrelatedtothepa1ent’scareandtreatments5.  Nameandcontactinforma1onoftheagency’sclinicalmanager

Confiden=alityofPa=entRecords! LinktoHIPAAprivacyrequirements

! PrivacyRule–protec1onofhealthinforma1on

! SecurityRule–imposessecurityrequirementsforagenciesandbusinessassociatesregardingconfiden1alityandintegrityofrecords

! BreachNo1fica1onRule–requirescovereden11estono1fyHHSofPHIbreaches

! HIPAArulesalsoprovideforpa1entrightstoobtaincopiesoftheirownrecordsandtorequestcorrec1ons

Pa=entInspec=onofRecords

! Pa1enthastheright,uponverbalorwriFenrequest,toreceivecurrentclinicalrecords

! ThisrequestwouldnecessitateprovisionofthePlanofCareaswellasotherrecords

! Electroniccopiesshouldbeprovidedatnochargeandhardcopiesmustbechargedataratenottoexceedthecommunitystandardforphotocopyingtherecord

! Timeframeforprovidingtheinforma1oniswithinfourbusinessdaysoratthenexthomevisit,whichevercomesfirst

Interpre=veGuidance–PaymentforServicesandChangesinCare

! Pa1ent’srecordmustincludedocumenta1onthatthepa1entwasadvised,priortothestartofservices,oftheextenttowhichservicesareexpectedtobereimbursedbyMedicare

! Documenta1onmustincludeinforma1onastopaymentsthatwouldbeexpectedfromthepa1entifotherreimbursementwerenotavailable

! Ifthepa1ent’scondi1onchangesandneworaddi1onalservicesarerequired,thesameadvanceno1fica1onmustoccurwithrespecttothoseservices

! No1fica1onmustincludeinforma1onaboutthehotlineandexpeditedappealrightsfordiminu1onofservices

Interpre=veGuidance–FederalandStateAssistance

! Pa1entsmustbegivencontactinforma1on–name,addressandtelephonenumber–ofthefollowingagencies:

! AreaAgencyonAging! CenterforIndependentLiving! Protec1onandAdvocacyAgency! AgingandDisabilityResourceCenter! QualityImprovementOrganiza1on

Interpre=veGuidance–FreedomfromReprisal

! Discrimina1onagainstapa1entwhohasfiledacomplaintisprohibited

! Discrimina1onisdefinedastreatmentthatdiffersfromthatprovidedtootherpa1entsfollowingacomplaintwithoutjus1fica1onofthedisparity

! Examplesinclude! Reduc1onofservices! Discon1nua1onofservices! Dischargewithoutmedicaljus1fica1onforthechange

§484.50d)–TransfersandDischarges! Agencymayonlydischargethepa1entunderlimitedcircumstanceswhichmustbedocumentedintheno1cetopa1ents! Necessaryforpa1entwelfare! Reimbursementnolongeravailable! Agencyandphysicianagreethatgoalshavebeenmet! Pa1entrefusesservicesorelectstobetransferred! Dischargeforcausebasedonagencypolicy! Pa1entdeath! Agencyceasestooperate

TransferandDischargeNo=fica=on! Advanceno1ceofthepoten1aldischargeortransfershouldbeprovided

! Pa1entpreferencesatthe1meofdischargeortransfermustbedocumentedandconsidered

! Pa1entshavetherighttorefusethetransferwhichmustbedocumented

! Pa1entsandrepresenta1veshavetherighttoappealthetransferordischargedecision

! Ongoingcommunica1onwiththepa1entandrepresenta1veduringtheprocessiscri1cal

Interpre=veGuidance–Transfer/DCforPa=entWelfare

! Invokedwhenthepa1entrequiresmorethanintermiFentservice

! Transferforspecializedservicesthattheagencycannotprovide! Expecta1onofpoten1aladverseoutcomethatpromptsthetransfer/DC

! Pa1entandphysicianmustbeinformedanddocumenta1onmustbepresentintherecord

! Alterna1veprovidersmustbeiden1fied

! Transfermustbefacilitatedbythehomehealthagencyandpa1entmedicalrecordmustbeprovidedtothereceivingen1typriortoorupontransfer

Transfer/DCforLackofReimbursement! Generallyinvolveslackofongoingmedicalnecessityforservices

! No1cemustbeprovidedatleasttwodaysinadvanceofcompletedischarge

! Somestatesrequiremoreno1cethatcangouptofivedays

! Lackofreimbursementduetoagencyfailuretocomplywithcoverageoreligibilityrequirements

Interpre=veGuidance–Transfer/DCwithGoalsMet

! Intentisthatwhenthepa1entisstabilizedandhealthandsafetygoalshavebeensufficientlymet,serviceswouldnolongerbeneededanddischargeisappropriate

! Ifpa1entdisagreeswiththedischarge,he/sheshouldbeapprisedoftheopportunitytoappealthedecisionaZerreceivingproperwriFenno1ceoftheintenttodischarge

Interpre=veGuidance–Transfer/DCforRefusalofServices

! Pa1entshavealwayshadtherighttorefuseservice

! Declinesofasingletypeofservicearedifferen1atedfromrefusalofservice

! Decliningservicefromapar1culardisciplinemaynotwarrantdischarge

! Refusalsthatwouldhavepoten1aladverseeffectsonthepa1entorcompromisetheagency’sabilitytosafelydelivercarecouldwarrantaDC

! Documenta1onofphysicianno1fica1onofdischargedecisionsshouldbecommiFedtothepa1ent’srecord

! Measuresthattheagencytooktoeducatethepa1entmustalsobedocumented

Interpre=veGuidance–Transfer/DCforCause

! Abusiveordisrup1vebehavior! Threats-bothverbalandnon-verbal! Sexualharassmentorotherincidentsinvolvingthesafetyofstaff

! Otherimpedimentstothesafedeliveryofcare

! Repeateddeclina1onofserviceorpersistentandcounterproduc1vehos1leantudesandbehavior

No=fica=onRequirements–DCforCause! Pa1entandphysicianmusthaveadvanceno1cethattheDCisbeingconsidered

! Othersalsocaringforthepa1entshouldalsobeno1fiedpriortoDC

! Clinicalrecordmustreflect! Problemsencounteredwiththepa1ent! Assessmentofthesitua1on! Communica1onwithmanagementandthephysician! Planforresolvingissues! Resolu1onimplementa1onresults

DCforCause–ImmediateAc=onExcep=on! Whenstaffarethreatenedorendangered

! Canopenthedoorforimmediateac1onwithoutaplantoresolvethesitua1on

! Evidenceshouldbeintherecordthattheagencyprovidedthepa1entand/orrepresenta1vewithinforma1ononalternatecommunityresources

! Pa1entsandrepresenta1vesshouldalsobegivennamesofotheragenciesthatmightbeabletoprovideservice

Interpre=veGuidance–AgencyCessa=onofServices

! Agencyisunabletocon1nueopera1ons! Sufficientno1ceofplannedcessa1onofbusinessisrequired

! Pa1entsmustbegiveninforma1onofotherproviders

! Agencymustfacilitatethesafetransferofpa1entstootheragencies

AgencyIssues–LackofAvailableStaff! NotaddressedintheInterpre1veGuidancebutwascoveredintheFRcomments

! Lackofstaffisnotconsideredanappropriatereasontodischargeortransferapa1ent

! Agencyisresponsibleforassuringavailabilityofstaffwhenthepa1entisadmiFedforcare

AgencyFailures–Acquisi=onoftheF2F! NotaddressedintheInterpre1veGuidancebutwascoveredinthecommentsintheFR

! CoveragerequirementsnotbeingmetduetofailuretocompletetheF2Fshouldbe‘excep1onallyrare’giventhe120day1meframe

! WhentheF2Frequirementisnotmet,theagencycannotholdthepa1entaccountableforpayment

! TheHHAisalsoprecludedfromanabruptdischargethepa1entunlessthereisproperno1fica1onandavaliddischargereason

§484.50(e)–Inves=ga=onofComplaints! Theagencymustinves1gateallcomplaintsmadebypa1ents,theirrepresenta1ves,caregiversandfamily

! Treatmentorcarethatis–orfailstobe–furnished

! Inconsistenttreatment

! Inappropriatetreatment

! Mistreatment,neglectorverbal,mental,sexualorphysicalabuse

! Misappropria1onofproperty

Documenta=onandHandlingofComplaints! Allcomplaintsmustbedocumented

! Includesboththeexistenceofthecomplaintandtheresolu1onthatwasachieved

! Ac1onmustbetakenbytheagencytoavoidfurtherpoten1alviola1onsincludingretalia1onagainstthepersonwholodgedthecomplaint

! AgenciesshouldalsopaycloseaFen1ontostatelawsandrequirementsrelatedtocomplaints

Complaints–AgencyStaffObliga=ons! Whetherdirectlyemployedorprovidingservicesunderarrangement

! Normalcourseofprovidingservicestopa1ents

! Iden1fica1onofincidentsorcircumstancesthatcouldbesugges1veofmistreatment,neglect,abuseorinjury

! Iden1fica1onofmisappropria1onofpa1entproperty

! Allactualeventsorincidentsmustbepromptlyreportedtotheagencyandotherappropriateauthori1es

Interpre=veGuidance-Complaints! Systemsmustbeinplacetorecord,trackandinves1gatecomplaints

! WriFenpoliciesandprocedures! Acceptanceofcomplaints! Processingcomplaints! Complaintreviewandinves1ga1on1meframes! Resolu1onandoutcomes! Communica1on

Interpre=veGuidance-Complaints! Complaintinves1ga1onsshouldbepartoftheQAPIprogram

! Duringasurveytheagencyshouldbeabletoprovidedocumenta1ontoconfirmthatinves1ga1onswereconducted

! Documenta1onshoulddescribeanyac1onstakenbytheagencytoremoveriskstothepa1entduringcomplaintinves1ga1ons

§484.50(f)-Accessibility! Informa1onmustbeprovidedinplainlanguageandinanaccessiblemanner

! Personswithdisabili1esmustbegivenaccesstowebsites

! Auxiliaryaidsandservicesmayberequiredandcannotbeatacosttothepa1ent

! ThosewithlimitedEnglishmustbeabletoaccessinterpre1veservicesandwriFentransla1onsofdocumentsatnocosttothepa1ent

§484.40-ReleaseofOASISInforma=on! AgenciesmusthavewriFencontractswiththirdpar1esthatprocessOASISinforma1on

! Contractsmustobligatethepar1estoensureprotec1onofpa1entiden1fiableinforma1oncontainedinthemedicalrecordincludingOASISdata

! Confiden1alpa1entinforma1onmaynotbereleasedtothepublic

§484.45–Repor=ngofOASISInforma=on! OASISdatamustbeencodedandtransmiFedtotheCMSsystemwithin30daysoftheassessmentcomple1on

! OASISdatamustaccuratelyreflectthepa1ent’scondi1on

! ThetransmiFalformatmustmeetCMSrequirements

! TransmissionsoZwaremustconformtoFIPS140-2standards

! Branchiden1fica1onnumbersmustbeincluded

Interpre=veGuidance-OASIS! Agenciesareresponsibleforthepoliciesoftheirvendorsrelatedtosecurity,confiden1alityofinforma1on,andimpermissibleusesordisclosures

! Agenciesmustensurethattheirworkforcesarecompliantandthattheirvendorsalsohavecomplianceproceduresinplacetoprotecttheconfiden1alityofpersonalhealthinforma1on

! “TheHHAisul1matelyresponsibleforcompliancewiththeseconfiden1alityrequirementsandistheresponsiblepartyiftheagentdoesnotmeettherequirements.”

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