| 6500.121(a) | Individual #1 had a physical examination completed on 1/4/24 and then again on 2/14/25, exceeding the annual requirement. | An individual shall have a physical examination within 12 months prior to living in the home and annually thereafter. | Plan of Correction:
6500.121 (a) An individual shall have a physical examination within 12 months of living in the home and annually thereafter.
Individual #1 had a physical examination completed on 1/4/24 and then again on 2/14/25, exceeding the annual requirement.
It is important to note that Individual#1 was scheduled for their annual physical on 1/14/2025. At check in, s/he was informed that with his/her new insurance plan, which went into effect 01/01/2025, requires the physical exam to be completed in 2 parts: the initial ¿Wellness Exam¿ in which a series of questions are answered by patient/participant along with vitals, vision, and hearing screenings completed. The second part is the exam with Primary Care Physician (PCP) (which must occur on a separate billing day) is a systems check and is completed and verified by PCP for billing. Individual #1 requested to decline the ¿wellness exam¿ as they felt this was medically unnecessary and a waste of their time and resources. Individual#1 was informed by receptionist that the wellness exam is required and could not be declined, unless the patient wanted to self-pay for their annual physical exam. Individual#1 then informed the receptionist they would need to have the second part of physical completed by 1/19/25 (for regulatory compliance since previous physical was completed 01/04/2024) and was informed there were no available appointments prior to that date. Individual#1 requested to be placed on a cancellation list should an earlier appointment come available. The earliest available appointment wasn¿t until 2/14/25 which was when the second part of the physical was completed and verified by PCP. Individual#1 voiced dissatisfaction with not being informed of this billing/insurance requirement when the appointment was scheduled and was informed by receptionist there was nothing more they could do. Per best practices, this was noted in the clinical file by LS Director on 1/15/25.
What specific change will be made?
Annual physical exams will be scheduled to be completed no later than 380 days from the previous physical exam. (1 year + 15 day grace period). 6 months prior to the date the exam needs to be completed, life sharing provider (LSP) will schedule the physical exam, ensuring to ask during scheduling what the insurance carrier/provider requires (some plans are 2 visits while many other plans/providers require just 1). Due to high probability of cancellation, LSP will request 2 appointments to be scheduled within the 380-day window to ensure regulatory compliance. LSP will request of scheduler to make a special note in calendar that the 380 day window must be observed for regulatory compliance and to call ASAP if a scheduling issue is known. LSP will provide the scheduled dates to LS Director/Program Specialist (LSD/PS), for tracking/compliance. At the beginning of the month the annual physical is due, LSD/PS will contact Individual/LSP to confirm appointments are still scheduled by required due date and will provide the required annual physical examination form to Individual/LSP. On the day annual examination is completed, Individual/LSP will confirm compliance with LSD/PS by providing the completed annual physical examination form to be added to individuals¿ clinical file. LSD/PS will confirm regulatory compliance by adding completed date to tracker and updating LII. If second scheduled appointment no longer needs to be kept, LSD/PS will notify Individual/LSP that they may call to cancel that appointment. A request will be made to individual¿s Rep Payee for written notification to be made to Individual and LS Director if medical insurance carrier/plan changes.
Who will make the change?
Life Sharing Director and Life Sharing Program Specialist
When will the change be made?
8/22/2025
How will the change be made?
¿ LSD will create an annual examination due date tracker and will update it as examinations are completed throughout the year.
¿ LSD/PS will provide Annual Medical Due Dates Form to all individuals/LSP¿s and will educate both on why compliance with this regulation is necessary and the steps of plan of correction which they will be responsible for by 8/25/25.
¿ LSD/PS will ensure annual physical examinations are scheduled within the required time frame by requesting the appointment is made no less than 6 months prior to due date. A 30-day reminder will be initiated by LSD/PS. A 7-day reminder will be initiated by LSP/PS.
¿ LSD/PS will provide the required form at the beginning of the month appointment is due.
¿ LSD/PS will place the completed physical examination form in the clinical file within 5 days of the visit.
¿ LSD/PS will conduct monthly medical record checks to verify upcoming due dates and appointment confirmations.
¿ LSD will ensure on-going compliance with this regulation is captured on the LII tool effective 8/15/25 through 8/15/2026 for each individual served in life sharing.
What system have you implemented to make sure the same violation will not occur again?
¿ Annual Medical Due Dates Form
¿ Central Tracker for when examination due dates are scheduled and completed.
¿ Reminder Workflow: 6-month reminder, 30-day reminder, 7-day reminders
¿ Monthly Record Reviews
¿ 6500 Licensing Inspection Instrument (LII)
What training will be provided to your staff?
¿ LSD will train PS on all elements of approved Plan of Correction.
¿ LSD/PS will educate Individual/LSP of new process/plan of correction and will provide updated Annual Medical Due dates form to Individual/LSP.
¿ LSD will inform Rep Payee of the need for medical insurance plan updates/changes in order to remain in compliance with this regulation.
¿ LSD will update agency Compliance Officer and Chief Program Officer of the approved Plan of Correction to ensure transparency and opportunity for increased internal audits. |
08/22/2025
| Implemented |