Healthcare Standards and Compliance

Healthcare standards and compliance requirements affect any size organization. Whether you are a single provider or an organization with two or more providers, the requirements are the same. Beyond the standard business regulations outlined by OSHA and the EEOC, the Department of Public Welfare and the Centers for Medicare & Medicaid Services (CMS) outline the standards for home and community-based care organizations.

In Pennsylvania, PA Code Title 55 (Human Services) § Chapter 51 (Office of Developmental Programs Home and Community-Based Services) specifies the program and payment requirements for providers participating in the Adult Autism, Consolidated and P/FDS Waivers. The code regulates the service provision governed by the Department of Human Services designed to protect the health and welfare of individuals with intellectual disabilities. The code specifically addresses the provider qualifications and participation outlining everything from:

* Proper training and certification of workers
* Documentation of worker training and certification
* Participant Documentation
* Department approved services plans
* Type, scope, amount, duration, and frequency of service
* Participant eligibility
* Documented progress towards outcomes and goals
* Incident reports
* And, much more

In order for an individual with an intellectual disability to live a life that is as close to members of their community, a residential service must be provided with integration into the community. The design of the service should be made with the individual’s unique needs in mind as outlined in their Individual Support Plan (ISP). Chapter 6400 provides a licensing inspection instrument designed to measure compliance with community-based homes allowing providers to support these individuals and their unique needs. It outlines the minimum requirements to maintain proper compliance and reporting documentation.

The scope of these requirements are immense and, if done manually, can result in errors or omissions.

Equally prevalent is that the industry does not have national standards and are highly dependent on state requirements along loosely defined federal regulations. The National Alliance for Direct Support Professionals outlines standardized skills sets and competencies, licenses, certifications, training, and ethic standards to create more standardized approaches for DSPs, yet requirements can vary from state to state.

**The Balancing Act – Staying Current**
As an agency, your role is to facilitate the hiring, onboarding, management, scheduling, documentation and all other daily activities associated with participant care. While each day the type of activities are similar, every day is different based on the individual support plan.

Let’s face it – the only constant is change! Keeping up with the ever-changing regulations is a daunting task. It’s almost as difficult as the changing tax code yet worse. This year, the state of Pennsylvania implemented regulatory changes to be effective January 1, 2018. The code changes represent the greatest number of changes *ever* at one time. Another uncertainty is the possible, or inevitable, reformation of Obama-care.

The consequences are colossal. Regulatory fines for non-compliance can be steep, reaching up to $50,000 or more per incidence and may even result in being shut down. When regulations change, office systems and procedures also need to be altered to remain compliant.

As a business leader and a direct support professional, your focus is to ensure that all participants achieve the highest standard of outcomes and goals. This is only accomplished through your continued dedication to their individual support plans or ISP and communication with the care team and family. There’s minimal time left to manage the business, enter all required reporting documentation and growing and maintaining your business.

Optonome is designed to provide providers with a mobile, communications, training and management platform to save time and money. The platform is compliant with all federal and state regulations and reporting requirements, which are maintained for you. The mobile capability allows you to maintain your data online and easily access your reports when necessary. Optonome can help you optimize your business while you focus on the most important part of your business – participant care.