Home Health & Hospice Week

Medicare surveyors cited hundreds of agencies on administrator CoP since new requirements took effect.

Be sure you aren’t cruising for deficiencies related to your administrator on your next survey. Review the Home Health Condition of Participation ruling the matter:

42 CFR 484.105 Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished.

484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency’s overall management and operation, the provision of all home health services, fiscal operations, review of the agency’s budget and its operational plans, and its quality assessment and performance improvement program.

      484.105(b) Standard: Administrator.

          484.105(b)(1) The Administrator must:

               484.105(b)(1)(i) Be appointed by the governing body;
​               484.105(b)(1)(ii) Be responsible for all day-to-day operations of the HHA;
​               484.105(b)(1)(iii) Ensure that a clinical manager as described in paragraph (c) of this section is available during all operating hours;
​               484.105(b)(1)(iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies.

Interpretive Guidelines

In an August 2018 Quality, Safety & Oversight letter, the Centers for Medicare & Medicaid Services issued the final Home Health Interpretive Guidelines for surveyors.

IGs for §484.105(b)(1) state that “‘Report to’ means the administrator reports directly to the governing body with no intermediaries.”

Tags surveyors may cite for deficiencies related to these requirements are G940, G942, G944, and G946.

Since the CoPs took effect in January 2018, surveyors have cited 102 home health agencies for G940, 88 agencies for G942, eight agencies for G944, and 28 agencies for G946, CMS reports in its Quality Certification & Oversight report.

Note: The CoPs final rule is at www.govinfo.gov/content/pkg/FR-2017-01-13/pdf/2017-00283.pdf. The IGs are at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-25-HHA.pdf. Updated survey deficiency data is available at https://qcor.cms.gov.