Home Health & Hospice Week

Payment suspension sanction gets a little less punishing.

Starting next summer, surveyors may start deploying their new weapons that could sink your home health agency.

HHAs should start now in getting familiar with the new survey tools, advises Washington, D.C.-based health care attorney Elizabeth Hogue.

Agencies can get to know the basics in the 2013 home health prospective payment system final rule, then drill into the specifics when the Centers for Medicare & Medicaid Services issues its State Oper-ations Manual revisions and interpretive guidance on the sanctions next year. Experts predict the manual and guidance will arrive anywhere from spring to fall.

Just because CMS hasn't gotten the provisions on the books, don't expect surveyors not to use the new tools, experts warn. However, at least CMS has delayed implementation of the most onerous sanctions -- civil money penalties and payment suspensions -- until July 2014.

Here are the new sanctions, which Medicare may impose individually or together:

• Civil Money Penalties. Surveyors can impose CMPs on a per instance or per day basis. Fines will range from $500 to $10,000 per day or instance (see story, p. 324).
• Payment suspension. CMS will be able to impose payment suspensions for new admission, but not new episodes as originally proposed (see story, p. 322). HHAs will not be eligible for repayment after correcting the deficiencies.
• Temporary management. A CMS representative or CMS "authorized agent" would be appointed. The HHA will pay the new manager's salary directly.

Commenters really did not like this sanction, but CMS stands firm. It also clarifies what a manager's duties must include. "The HHA's governing body must ensure that the temporary manager has authority to hire, terminate or reassign staff, obligate funds, alter procedures, and manage the HHA to correct deficiencies identified in the HHA's operation."

• Directed plan of correction. CMS or the temporary manager must develop specific POC actions, which would include patient outcomes and deadlines.
• Directed in-service training. Training will be based on staff's "lack of knowledge" that led to a deficiency and would retrain "the staff in the use of clinically and professionally sound methods to produce quality outcomes," the rule says.

In choosing sanctions, surveyors will rely on the following six factors, CMS says in the rule:

1. Whether the deficiencies pose immediate jeopardy to patient health and safety;
2. The nature, incidence, degree, manner, and duration of the deficiencies or noncompliance;
3. Repeat deficiencies, the HHA's compliance history in general, and specifically with reference to the cited deficiencies, and any history of repeat deficiencies at either the parent or branch location;
4. Whether the deficiencies are directly related to a failure to provide quality patient care;
5. Whether the HHA is part of a larger organization with documented performance problems;
6. Whether the deficiencies indicate a system wide failure of providing quality care.