Termination - SA Documentation Requirements

3018 - Termination - SA Documentation Requirements (Rev. 1, 05-21-04) 3018A - Documentation to Support Proposed Termination (Rev. 1, 05-21-04) All documents to support a proposed termination must be complete, accurate, and logical in sequence. Each document must be dated and signed by the preparer or indicate the date of receipt in the SA. The documentation must be supported by a complete current survey report or, in the case of an HHA, required CMS forms. 3018A1 - Current Survey Report (Rev. 1, 05-21-04) The SA reviews the current survey report or required forms to ensure that all items are properly completed. If there are any changes or erasures, the SA initials the item and explains the basis for the modification in the explanatory remarks column. The SA includes the following information in the explanatory remarks column for each item “not met”: • A description of the deficiency; • Whether the deficiency existed during the previous survey and whether compliance was achieved, and then not sustained; and • Current PoCs, if any. In addition, the SA includes with the package an estimate of whether there is a prospect of compliance with all eligibility requirements within the time limits and the basis for this opinion. 3018A2 - Previous Survey Reports (Rev. 1, 05-21-04) The SA reviews previous survey reports for consistency. If a deficiency is reported on the current survey report that has obviously existed for some time, explain why it was not reported previously; e.g., serious structural defects, inadequate fire escapes. The SA explains any conclusions that might be questioned, especially if certain requirements are being weighed heavily. For example: • The majority of standards are “not met,” yet the Condition is found in compliance; or • A Condition is found not in compliance based upon the relationship of standards or other deficiencies not being met. 3018B - Record of Contacts With Providers/Suppliers (Rev. 1, 05-21-04) The SA includes in documentation copies of communications and written reports of oral communications with providers/suppliers including the date of contact, the person involved, the purpose, and the content of the communication. Also, the SA includes reports of investigations of complaints. 3018C - Notification to Provider/Supplier of Deficiencies and Recommendation of Termination (Rev. 1, 05-21-04) The SA includes in the file a copy of the letter notifying the provider/supplier of the deficiencies found on the survey and advising that failure to correct will result in a recommendation for termination and includes copies of any other SA notices to the provider/supplier.