Home Health & Hospice Week

If your larger organization has troubles, then sanctions are more likely.

One of the scariest things about the upcoming CMP and payment suspension sanctions is that it’s up to the surveyors’ discretion when to use them and how severe they will be.

"I will … admit that’s very difficult," a CMS official said about how to determine which sanctions apply at what level. But the Centers for Medicare & Medicaid Services is furnishing some guidelines on how to determine the level of sanctions to impose, said CMS’s Pat Sevast at the National Association for Home Care & Hospice annual meeting in Washington, D.C. on Nov. 1.

Surveyors will use these factors to determine sanctions and CMP levels, which apply only for condition-level deficiencies:

• Seriousness — Immediate Jeopardy or Non-IJ;
• The nature, incidence, manner, degree, and duration of the noncompliance;
• Overall compliance history, presence of repeat deficiencies;
• Extent to which the deficiency is related to failure to provide quality care;
• Extent to which agency is part of larger organization with performance problems; and
• Indication of system-wide failure to provide quality care.

Civil money penalties will fall into three categories. For immediate jeopardy deficiencies, HHAs can be subject to CMPs of $8,500 to $10,000 per day or per instance. For non-IJ deficiencies that involve patient care, CMPs can range from $1,500 to $8,500. And for non-IJ, non-patient care focused deficiencies, CMPs can be from $500 to $4,000. Patient care versus process-oriented deficiencies is an important distinction for choosing sanctions, Sevast stressed.

Commenters on the rule took issue with the factor looking at the agency’s larger organization, Sevast said in the session. But whether the problem is one isolated at one agency or spread out over an entire chain is important. If the problem is isolated, then the chain won’t be a factor, Sevast expects. The same goes for agencies that are part of a larger hospital/health system.

But when the problem seems to be originating with chain or health system management, that "will probably be taken into consideration," Sevast highlighted.

It’s not up to you: Remember that it is not the provider’s choice whether to receive sanctions, Sevast told attendees. Rather, the State Survey Agency and CMS Regional Office will decide whether sanctions apply and at what level.