HAAD Standards for Homecare Health Services in Emirate of Abu Dhabi Document Ref. Number: HAAD/AHHS/SD /1.4 Version: /03/2016 Effective Date:

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1 Document Title: HAAD Standards for Homecare Health Services in Emirate of Abu Dhabi Document Ref. Number: HAAD/AHHS/SD /1.4 Version: 1.4 Approval Date: Document Owner: Applies to: Classification: 15/03/2016 Effective Date: 15/03/2016 Health Regulation, Health Financing and Strategy Division Healthcare Facilities seeking to Provide Health Care Services in The Home in the Emirate of Abu Dhabi Public 1. Purpose 1.1This standard sets out the service requirements for homecare health services to ensure high quality, safe and accessible clinical care for patients. In doing so the Standard: Mandates the licensing requirements for facilities and health professionals seeking to provide homecare health services in Emirate of Abu Dhabi; Sets out the scope of clinical services to be provided in the home setting; Sets out the patient eligibility requirements; Assures the continuity of care for patients discharged from an in-patient setting to the home setting and for whom healthcare in the home is deemed necessary by their health condition and supported by evidence; and Facilitates access to proactive checkups as well as convenient and timely indicated follow up to help prevent and manage disease for home-bound patients, including access to rehabilitation, palliative care for pain and symptom management for the terminally ill patients. 2. Scope 2.1 This standard applies to limited categories of HAAD defined healthcare facilities as per Section 9, determined by HAAD as eligible to apply for license to provide healthcare services in the home in the Emirate of Abu Dhabi. 2.2 This Standard also applies to HAAD licensed healthcare professionals employed by a HAAD licensed Healthcare Provider to Provide healthcare services in the home. 2.3 Patients who require and are eligible for healthcare services in the home, including adults and children. Page 1 of 11

2 3 Definitions 3.1 Home bound: The referring physician has certified the patient to be: Medically confined to their home and requires skilled nursing; Due to an illness or injury resulting in the patients inability to leave the patient s place of residence without assistance by another individual or the aid of a supportive device; OR Have a condition such that leaving the place of residence is requires a taxing effort or is medically contraindicated; Exceptions: The patient may leave their residence for absences that are infrequent in nature and/or short in duration (examples include: seeking medical care, personal care, attending religious service, family event, memorial service) The patient is under the care of a referring physician (Appendix 1); Referring physician must be a HAAD licensed consultant or specialist physician, whose specialty is related to patient s diagnosis The patient receiving services under a plan of care established and periodically reviewed by the treating physician on a face to face basis within a maximum of 60 day intervals; and The patient is in need of skilled nursing care which may on an intermittent or continuous basis or be in need of supportive care or specialised therapy at home. 3.2 Patient: A person who is served by, or uses the services of a HAAD licensed Healthcare Provider for the provision of healthcare services in the home. 3.3 Home Healthcare Service Provider: A Healthcare Facility or Provider that is licensed by HAAD to provide home healthcare services. 3.4 Home Healthcare Services: Is a service that is Authorised by HAAD and by its nature requires the skills of a nurse or medical professional to be provided safely and effectively and continues to be a skilled service (includes education to patient, care giver or family member). Services include: Screening and follow up health services; Observation and assessment of unstable medical conditions; Clinical treatment; Care and support services; and Teaching and Training Activities (patient education) The skilled nurse service is reasonable and necessary to the diagnosis and treatment of the patients illness or injury within the context of the patient s unique medical condition; The service is Led by a physician and require the skills of a registered nurse as per HAAD PQR Includes the delivery of medicine supplies, the setting up of medical equipment, delivery of associated care that is initiated by the treating physician from an inpatient setting that is authorised for delivery of home healthcare services. All services delivered in the home are consented by the patient or their Substitute Consent Giver; and Services covered include: skilled nursing services that are necessary to maintain Or improve, the patients current condition, prevent or reduce further deterioration so long as the patient requires skilled care for the services to be safely and effectively provided. Exclusions include: Where the individualised assessment does not demonstrate such a necessity for skilled care, including where services needed do not require skilled nursing care or therapy because they can be provided safely and effectively performed by the patient or unskilled care givers, Page 2 of 11

3 such services are not covered under the home health benefit If the nature of the services or ADL can be safely and effectively performed by a trained non-medical person, the services will be considered custodial care such as care provided for the comfort and convenience of the patient or family or child care. 3.5 Patient Plan of Care: An individualised Plan of Care devised through a multi-disciplinary team with supporting documentation for each patient as per Appendix 2. The plan of care includes skilled nursing and therapy treatment determined by the treating physician following consultation with qualified therapists and specifies the duration and expected patient outcome. 3.6 Physician Led Service: A home healthcare service with at a minimum of a HAAD licensed General Practitioner for direct patient care and clinical oversight of HAAD licensed Nurses. The Physician leads the service and is responsible to sign off the service providers home healthcare bi-annual self-assessment tool as set out at Appendix Specialised Therapy and Consultation Home Visits: Are skilled Health Services delivered by HAAD licensed professional or technical medical personnel in order to obtain the specified medical outcome, and provided safety to the patient. The conditions for this include: The patient is expected to improve at the end of their treatment plan Ordered and monitored by the treating physician; The service may include the following health services subject to HAAD approval: Speciality Physician Home Consultation; Emergency Home Visit by General Practitioner Physician (Follow-up or routine physician visits are excluded and will be billed (bundled) within the Pattern Of Care fees: Home Psychotherapy; Home Haemodialysis; Tele-monitoring Services; Home Chemotherapy; and Investigational and Screening Services (Including Point Of Care Testing, Radiology exam) Provision of other services are subject to HAAD approval 3.8 Continuous Nursing Care (CNC) long stay: Continuous nursing services for patient who requires more individualised nursing care and where longer duration of skilled service is required and recommended by the treating physician to be provided for extended periods up to 60 days, further extension of service must be recommended and determined by the assessing/treating physician and to be accompanied with supporting documentation. The service is typically 8-12hours and may extend to 24/7, and is provided to patients who are not expected to be improved for an extended period. 3.9 Intermittent Nursing Care (INC) and Nursing Visits (NV) : A skilled nursing service provided for fewer than 7 days each week or less than 8 hours each day (part time nursing care) for a period up to 30 days for patient, family or non-skilled care giver can be trained to provide a health service safely and effectively or for patients who are expected to improve over time, further extension of service must be recommended and determined by the assessing/treating physician and to be accompanied with supporting documentation. The treating physician who certifies the patient s eligibility for home health services, will be the same physician who establishes, signs the plan of care and determine the frequency and duration of service Supportive Home Health Services: The health care provider offers services that delivered by HAAD licensed health care professional at the patient home, and should be expected to result in a significant improvement in the patient health condition and Page 3 of 11

4 functional capabilities within a reasonable and defined period of time, or requires a skilled therapist to safely and effectively establish a maintenance therapy program Treating Physician: A physician who offers an opinion within his area of specialty AND has an established history of providing treatment to a patient for a specific condition, i.e. who furnishes a consultation and/or treats a patient for a specific medical problem, and who uses the results of a diagnostic test in the management of the patient s specific medical problem. A treating physician, by definition, is not simply a doctor who has seen a patient once or twice Referring Physician/Ordering Physician: A physician that directs a patient to an additional source of medical expertise for assistance, examination, information or treatment or therapy Other Specialised Services: Any new services can be delivered safely and effectively at the patient s home will be subjected to HAAD approval to be added and billed under the (Specialised Therapy) Domain Care giver: an unskilled person who is not licensed by HAAD and may be nominated or employed by the patient or their Substitute Consent Giver to assist and care for the patient on a day to day basis Multidisciplinary Team (MDT): is composed of members from different healthcare professions with specialised skills and expertise. The members collaborate together to make treatment recommendations that facilitate quality patient care Home care facility physician: Home care facility physician responsible to manage types of illness that present in an undifferentiated way at an early stage of development, which may require urgent intervention. Their duties are not confined to specific organs of the body, and they have particular skills in treating patients with multiple health issues to certain low levels of complexity. 1. Follow-up of chronic health problems, 2. The treatment of acute non-life-threatening conditions, 3. The early detection and referral to specialized care of patients with serious diseases, and 4. Preventative health care including health education and immunization. 4 Duties for Healthcare Facilities, Providers and Professionals All Healthcare Facilities and Professionals licensed by HAAD to provide healthcare services in the home must: 4.1 Provide only the healthcare services defined in this Standard, and in accordance with the specified requirements of this Standard, ensuring the highest standards of care and professionalism with the patient and their family members or carers; 4.2 Ensure that healthcare services are accessible to patients determined as eligible for these services, in accordance with the mandated criteria, and are offered in at least Arabic and English languages and/or as per patient needs; Providers must ensure staff are able to clearly communicate with patients their treatment plan and care before, during and after each visit. 4.3 Comply with the requirement to safeguard and preserve patient rights through treatment with dignity and respect, provision of the determined healthcare services in the home in accordance with this Standard and on the basis of clinical need, assuring professionalism and confidentiality during the course of providing healthcare services to the patient in the home; 4.4 Ensure all appendicies are utilised to document service activity; 4.5 Ensure risk assessments are undertaken in the home include staff security and safety; 4.6 Ensure patients and their families are informed of their rights and responsibilities; Page 4 of 11

5 4.7 Protect the privacy concerns of the patient and the confidentiality and security of their medical information and records when providing healthcare service in the home setting. Confidentiality, privacy and security of health data and records must comply with the Data Management Policy, Chapter VI, Healthcare Regulator Policy Manual Version 1.0, the HAAD Policy on Medical Records- Health Information Retention and Disposal and the HAAD Data Standards and Procedures Standard requirements and UAE Laws; 4.8 Comply with the data submission and reporting requirements specified in the Data Management Policy, Chapter VI, Healthcare Regulator Policy Manual Version 1.0 and set out in the Data Standards and Procedures (available from: Comply with HAAD requests to inspect and audit records and cooperate with HAAD authorised auditors, as required for inspections and audits by HAAD; and 4.10Comply with the health insurance and/or third party administrator appointed by HAAD to manage claims reimbursement requests to inspect and audit records and to cooperate with their auditors as required for inspections and audits. 4.11Comply with the healthcare service process for provision of healthcare services home as set out in this Standard and illustrated at Appendix Maintain confidentiality and privacy of during home visits as part of patient care. This includes maintaining confidentiality and privacy of any information obtained or observed during home visits Observations that highlight patient, family member, carer or wider public risk shall be reported to the competent authority. 5 Duties for Payers and Third Party Administrators (TPAs) All Payers and TPAs must 5.1 Comply with the provisions and specifications of this Standard in respect of healthcare services specified in this Standard as covered under the health insurance scheme; 5.2 Ensure that authorisation of healthcare services in the home for the purposes of coverage under the patients health insurance plan are completed within 24 hours Referrals from General Practitioners in remote areas, and in the absence of specialist may be accepted following submission of evidence privileges being granted as per HAAD Clinical Privileging Framework and compliance with the requirements set out in this Standard; Rules for reimbursement are set out at Appendix Ensure that referrals for home healthcare services have the appropriate documentation to evidence the need for home healthcare services and authorisation by the referring physician Billing and reimbursement of the Home Healthcare shall be in accordance with Standard Provider Contract, HAAD Mandatory Tariff and associated Claims and Adjudication Rules, and the Claims and Adjudication Standard; all documents are available at: Authorisation must be undertaken following initial and subsequent face to face patient assessment by the referring physician (Appendix 6). 6 Enforcement and Sanctions 6.1 Healthcare service providers must comply with the terms and requirements of this Standard, the HAAD Standard Provider Contract and the HAAD Data Standards and Procedures. HAAD may impose sanctions in relation to any breach of requirements under this Standard in accordance with the Complaints, Investigations, Regulatory Action and Sanctions Policy, Chapter IX, Healthcare Regulator Policy Manual Version 1.0. Page 5 of 11

6 7 Standard 1. Case Mix and Patient Eligibility 7.1 A patient is eligible for healthcare services in the home where: The referring physician has certified the patient to be medically confined to their home (as per section 3.1) and requires skilled nursing, therapy and supportive services Evidence of assessment, duration and proposed plan of care must be specified by the treating physician as per Appendix 2; The service to be provided in the home falls under those permitted under section 3.4 and is medically reasonable (able to be provided safely and effectively in the home setting) and necessary (determined on the basis of evidence-based practices) and the healthcare professional is eligible under the HAAD Licensure and Clinical Privileging Framework to provide healthcare services in the home; The patient presents in person (or via duly authorised guardian/carer) presents a referral for healthcare services in the home from the referring physician, as per section and Standard 2. Healthcare Services in the Home General Service Specifications 8.1HAAD licensed Healthcare Providers and Healthcare facilities HAAD licensed Providers for healthcare services in the home must ensure: All healthcare professionals employed by the facility are licensed by HAAD and Privileged to deliver health services in the home Assessment and evaluation is in accordance with the specifications of this Standard, taking into account the patient condition, reason with supportive evidence, duration, the eligibility criteria for healthcare in the home, type of service to be provided and the range of clinical services allowed in the home; The patient is referred to a healthcare provider licensed by HAAD to provide healthcare services in the home, and that such a provider has the range and scope of services required for the patient; The referring physician must not be the treating physician for home healthcare service however; both physicians should work together to improve patient outcome; Patients are assessed within 3 days from receiving a referral; Appropriate treatment plans are devised by a multidisciplinary team to meet the patient s needs including equipment and requisite medical supplies/consumables; visit protocol, duration, treatments and safety and assessment timeframe Multi-disciplinary teams engage in the assessment and provision of healthcare services in the home and comprise of healthcare professionals with the necessary qualifications and skills mix to provide quality and safe healthcare to patients in the home Healthcare professionals involved in the provision of Healthcare services in the home must restrict their practice to that permitted by their job description and privileges granted by the employing facility in accordance with the HAAD Clinical Privileging Framework and healthcare professional limits his/her Page 6 of 11

7 practice to that allowed by their respective HAAD license; The HCC lead physician is responsible to ensure the Patient care plan is delivered and adjusted Accordingly to meet the patient s needs Designation of clinical staff duties to achieve the care plan objectives shall be undertaken by the lead physician Patient education is delivered in a culturally and socially relevant manner and that information in support of healthcare services in the home are provided to the patient in accordance with the relevant HAAD policies and standard Patient review and assessment at the end of the home healthcare treatment plan must be undertaken by the treating physician through face to face consultation to assess progress and the need for any ongoing home care service There is a face to face follow up at the end of the specified treatment plan with the referring physician The responsibilities detailed in Appendix 1 and 2 are met prior to accepting a referral of a patient for healthcare services in the home; Quality management and training systems are established for The facility(s) scope of practice and ensure that such systems are consistent with internationally recognised evidence based practices and review and document the quality and safety of patient care regularly, adjusting own procedures as necessary. Evidence must be documented and maintained to demonstrate performance in patient safety and high quality clinical outcomes as per international recognised Standards; Healthcare professionals involved in the provision of Healthcare services in the home must develop, monitor and evaluate and revise patient care plans as per patient s assessment outcomes and healthcare needs; documentation of service assessment must be under taken by the home healthcare provider physician on a bi annual basis as set out at Appendix Healthcare professionals involved in the provision of healthcare services in the home must record and maintain patient care plans on patient files and ensure that members of the treating team involved (or to another homecare service if upon patient request or requested by the physician) in the care for the patient are provided appropriate handover and access to patients care plans and assessment outcomes; Healthcare professionals involved in the provision of healthcare services in the home providing peritoneal dialysis services or administering narcotics/controlled substances for pain management at the home must satisfy the requirements of certified training and special authorisation Page 7 of 11

8 as per the specifications set out in section 9 of this Standard Ensure emergency preparedness requirements are met for as per HAAD Standards No service provider is permitted to have the nursing staff housed at the patient s place of residence. 9 Standard 3. Licensure and Authorisation Rules 9.1 Healthcare facilities may seek to provide healthcare services in the home through one of the following: A new facility under New HAAD license application ; or An existing HAAD licensed facility under Authorisation. 9.2 Application for New License or Authorisation under existing license to provide healthcare services in the home is only available for the following Healthcare facility license types: Hospital (all subtypes); Centre/Clinic Office of Provision of Healthcare Services (this being a healthcare establishment which has higher level of healthcare management in the different fields of the health services, including but not limited to healthcare services in the home) All healthcare providers under the license category of provision of other healthcare services must present authorisation for service provision from the Ministry of Labour. 9.3 All Healthcare Providers must inform HAAD Facility Licensing for any addition or removal of home healthcare services. 9.4 All home healthcare providers must satisfy the following requirements for licensure: Newly authorised healthcare facilty shall be accredited by an internationally recognised accreditor for the provision of health services in the home within fifteen (15) months of HAAD licensure; HAAD will maintain a list of approved accreditors for home healthcare services Existing home healthcare providers shall be accredited by an internationally recognised accreditor for the provision of health services in the home within fifteen (15) months of issuance of this Standard; HAAD will maintain a list of approved accreditors for home healthcare services Meet a minimum requirement of one (1) General Practitioner and five (5) Nurses within six (6) months of issuance of this Standard; Submit quality and safety performance metrics as determined by HAAD upon licensure (Appendix 7). 9.5 Home Healthcare service authorisaiton, referral and treatment process are set out at Appendix 4; 9.6 Adhere to any other authorisation requirements set out by HAAD 9.7 The following requirements to provide healthcare services in the home must be met and evidenced for licensure and/or authorisation as set out in Table 1. Page 8 of 11

9 Table 1. Requirements for licensure Dimension Element Requirement A. General Considerations 1. Governance i. Governance and management a. Governance and management protocols defining clinical/medical, quality/safety and clinical performance roles and responsibilities, including job descriptions for staff; b. Quality and performance oversight, monitoring, documentation and management; 2. Facility Specific Policies and Standard Operating Procedures All Such Policies and Procedures to Comply with UAE and Abu Dhabi Laws and HAAD Policies Standards and i. Patient Access a. Provision of information to patients and their families on the healthcare services, the frequency and type of healthcare services to be provided to the patient, and the expected results of healthcare services provided; b. Provision of healthcare services in a language understandable by the patient and his/her family and that is culturally appropriate; c. Provision and management of patient referrals, and where required, transfers. ii. Patient Assessment: a. Have in place an assessment process to evaluate, monitor and document patient healthcare service needs, including, care planning and care outcomes. ALL assessments must be undertaken within 3 days of referral and reassessments by the treating physician must be undertaken in accordance to the patients care plan through face to face consultation b. Have in place a process to re-assess patients at appropriate intervals to determine the patients response to care and plan for any needs for continued/changed care requirements, and keep records of this on patient files; c. Have in place a process to refer patients for any additional assessment needs, when identified as necessary; d. Have in place policies, procedures and arrangements to provide clinical laboratory services and diagnostic imaging services and emergency management where required, and a process to facilitate patients access to these services; e. Have policies, procedures and appropriate forms for patient informed consent; f. Have procedures to tailor patient care plans to the individual needs of patients, to monitor and review progress/changed care needs and to document these on patients records; g. Have in place policies and procedures in support of patient medication management, including for the preparation, dispensing, storage administration and monitoring as well as reporting of adverse drugs reactions or medication errors Page 9 of 11

10 B. Service Operation Considerations 3. Policies and Standard Operating Procedures (SOPs) for Patient Identification and Data Management - All Such Policies and Procedures to Comply with UAE and Abu Dhabi Laws and HAAD Policies and Standards 1. Infrastructure Equipment and support services 2. Quality assurance and measurement i. Standard Operation Procedures a. Appropriate SOPs for patient identification and identity authentication in the home setting; b. Appropriate SOPs to secure and protect patient data and medical files when in the home setting; c. Risk management and data/file recovery protocols d. Observations that highlight patient, family member, carer or wider public risk shall be reported to the competent authority. i. Equipment and Supplies a. Have in place the requisite equipment and supplies in support of the range of clinical and healthcare services (refer to Section 8 of this Standard) to be provided to patients in the home setting; b. Environmental and occupational health and safety policies and procedures to tailored to the provision of service in the home of the patient and compliant with HAAD requirements (Chapter VI, Healthcare Providers Policy Manual, Version 1.0 and the HAAD Standards for Health Sector EHSMS Requirements); including for infection prevention and control, management and safety of the environment, and staff education; c. Technologies to support case management, communication with the patient and referrals, where required including in cases of emergency. i. Treatment Protocols and Training a. Standardised treatment protocols using evidence based guidelines for each of the clinical services they intend to provide, and evidence that these are implemented and updated in accordance with evidence; b. Training and certification of professionals and staff, including special authorisation for healthcare professionals engaged in providing peritoneal dialysis services and/or pain and symptom management using narcotics and controlled drugs. Facilities seeking to provide: ii. Peritoneal dialysis a. peritoneal dialysis services at home, must satisfy the following requirements: Submit special request seeking authorisation to provide peritoneal dialysis in the home; and Provide evidence that the HAAD licensed healthcare professionals providing this service have successfully completed certified training and received certification/accreditation and that they work within their scope of practice and the scope of service of the facility. iii. Pain management a. Provide pain management using narcotics and/or controlled drugs must satisfy the following Page 10 of 11

11 iv. requirements: Submit special request seeking authorisation to provide narcotics and/or controlled drugs in the home (HAAD Narcotics and Controlled Drugs Standard); Provide evidence that the HAAD licensed healthcare professionals providing this service have successfully completed certified training and received certification/accreditation and that they work within their scope of practice and the scope of service; and Provide evidence that the facility is equipped to provide 24hour emergency provision in the event of need for advice, support and/or intervention for acute symptom management and/or admission to an appropriate inpatient setting; Jawda reporting a. Establish metrics and indicators and measurement protocols to plan and measure quality improvement and patient safety, which must include indicators to assess clinical and service delivery aspects b. Comply with Jawda reporting and performance requirements Page 11 of 11