Home Health & Hospice Week

Expect a learning curve as survey results come in.

Home health agencies have been working fast and furiously to get into compliance with the new Home Health Conditions of Participation that take effect in less than a month, but even the best efforts may fall short. And that could leave providers open to punishing alternative sanctions or even agency closure.

Good news: The Centers for Medicare & Medicaid Services has announced that Medicare surveyors won't impose Civil Money Penalties for the first year the new CoPs are in effect (see Eli's HCW, Vol. XXVI, No. 43). That's fortunate, because attorney Robert Markette Jr. with Hall Render in Indianapolis expects "to see widespread noncompliance" when the CoPs first become active Jan. 13, he says. In fact, CMS's expectation of noncompliance may be why it is suspending the use of CMPs for the introductory year, Markette suggests.

Bad news: While CMPs may be off the table, other sanctions such as payment suspensions are not, and CoPs expert Sharon Litwin with 5 Star Consultants in Camdenton, Missouri, expects there to "be many areas of noncompliance seen with the new CoPs," she tells Eli.

Instead of lifting only CMPs for the year, "I so wish ... CMS would give a grace period for compliance - i.e. no condition levels," Litwin says, calling the move fair. "But they won't," she laments. Instead, HHAs will have to hit the ground running when CMS implements the CoPs in the new year. Granted, CMS did give agencies an extra six months to comply, moving the original deadline from July 2017 to January 2018 (see Eli's HCW, Vol. XXVI, No. 14). But the draft Interpretive Guidelines for the CoPs came out only in late October, and they were underwhelming at best, experts agreed.

"Agencies have been working diligently to get ready, but I am not sure that we really understand what the surveyors are going to be looking for," Markette worries. "The draft IGs were not nearly as helpful as we had hoped, which leaves agencies implementing policies, procedures, and forms without as much clarity as in the past."

Home care providers "will genuinely try to comply," believes Julianne Haydel with Haydel Consulting Services and The Coders in Baton Rouge, Louisiana. But "there will be widespread noncompliance for a while," Haydel expects.

Hopefully surveyors will "take into consideration the newness of the regs when issuing tags," Haydel continues. But make no mistake - "tags will be issued," she stresses.

Based on the many mock surveys Litwin has conducted this year and from those attending her CoPs education sessions all over the nation, "there will be many areas of noncompliance seen with the new CoPs," she concludes.

Red flag: "I would expect that surveyors will be particularly hard on agencies that have not made any effort to comply" with the new CoPs, Haydel tells Eli. "And there are plenty of those," she adds.

One group of agencies should be having an easier time getting in line with the new CoPs, expects consultant Anna Doyle with Laff Associates in Hilton Head Island, South Carolina: those with accreditation. "Accredited agencies are familiar with everything included in the 2018 CoPs," Doyle says.

For example: "Many non-accredited agencies have never developed an actual Quality Assurance and Performance Improvement program to systematically evaluate functions and processes within the organization," Doyle maintains. "Many HHAs have only considered a review of clinical records and a complaint process as their Quality program."

As surveyors hand down citations, agencies will get a better idea of where CMS is falling in a number of current gray areas, experts believe. In turn, based on that information, agencies will be able to update their processes to meet the conditions, says consultant and occupational therapist Karen Vance with BKD in Springfield, Missouri.

"The survey process is going to result in the industry learning more and more about what CMS intended," Markette agrees. But flaws in the survey process may make that learning process challenging (see story, p. 346).

Note: The CoPs final rule is at www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf.