Home Health & Hospice Week

Watch out: New ‘extended surveys’ will dig deep into your business.

In order to begin handing out those new alternative sanctions, the Centers for Medicare & Medicaid Services will start dropping in on your home health agency to perform ambush-style surveys.

As part of the alternative sanctions that CMS introduced in the CY2013 Home Health Prospective Payment System final rule, you now have a laundry list of brand-new survey practices to worry about. CMS introduced a myriad of new definitions and requirements for HHA surveys.

"Although these definitions are being added to the regulations by the Final Rule, many have been part of longstanding CMS policy," according to the Hall Render Killian Health & Lyman law firm’s blog. CMS will use the survey results "to determine if it will enter into, deny or terminate a provider agreement with an HHA."

Working on CMS’s behalf, State Survey Agencies will gauge HHAs’ compliance with conditions of participation via several tiered survey processes -- mainly three types of surveys:

• Standard Survey;
• Partial Extended Survey; and
• Extended Survey.

Expect an In-Depth Standard Survey Every 3 Years

The final rule provides that SSAs will conduct "standard surveys" every 36 months. According to the Maryland National Capital Homecare Association, the standard survey will review:

• A case-mix stratified sample of patients receiving services or items from your HHA;
• A visit to patients’ homes and, where appropriate, follow-up communications such as telephone calls to patients;
• A review of designated indicators of quality care, including medical, nursing and rehabilitative care;
• A review of select regulations most related to quality of care.

The final rule also establishes "abbreviated standard surveys," which would focus on a specific task relating to a particular issue. For example, an SSA may conduct an abbreviated standard survey in response to a complaint that CMS received, a change of HHA ownership, or a change in management. But the surveyor can still examine any areas of concern during the abbreviated survey, even if they don’t relate to the original issue.

Standard surveys will be "unannounced," according to the final rule. Further, CMS has charged SSAs with conducting surveys "with procedures and scheduling that renders the onsite surveys as unpredictable in their timing as possible."

No reprieve: CMS is so firm on the element of surprise that it will review SSAs’ scheduling and survey procedures "to ensure that the agency has taken all reasonable steps to avoid giving advance notice to HHAs of impending surveys," the final rule states. Also, anyone who notifies an HHA of the time or date of a standard survey will be slapped with a civil money penalty of up to $2,000.

Beware: Suspicions of Deficiencies Trigger Partial Extended Surveys

A "partial extended survey" will focus on CoPs that the SSA did not fully examine during the standard survey, MNCHA says. You’ll have a partial extended survey if the surveyor:

• Believed that deficient practice existed at a standard- or condition-level that was not examined during the standard survey; and/or
• Identified a standard-level noncompliance.

What to expect: During the partial extended survey, the surveyor will primarily focus on the identified or suspected deficient practice from the standard survey, along with additional standards under the same CoP in question. Plus, the surveyor may also look at conditions related to the deficiency. SSAs will conduct partial extended surveys within the same time interval as the initial standard survey, the final rule states.

Extended Surveys Will Test Your Stamina

"Extended surveys" review your HHA’s compliance with all CoPs and standards, MCHA explains. The SSAs must conduct extended surveys when there’s evidence of substandard care or CoP noncompliance.

Caveat: SSAs can also perform extended surveys anytime at their or CMS’s discretion. And if your HHA is subject to an extended survey, you can expect surveyors to scrutinize your policies, procedures and practices ��" specifically those that led to the substandard care and condition-level noncompliance. But surveyors can, at their discretion, minimize or maximize their investigative scope, based on the nature and extent of problems identified in the standard survey.

"We regard the statutory directive for an extended survey pursuant to a finding of substandard care to mean that CMS should make a deeper inquiry (via an extension of the survey) when findings are serious, and that we ought to calibrate the extent of the inquiry to the degree of risk to patients," the final rule says.

Timeframe: Although the final rule provides no specific timeframe for conducting partial extended surveys, CMS states that SSAs must conduct extended surveys within 14 calendar days following the standard survey’s completion.

Coming up: "CMS stated that [it] will engage industry, patient advocacy organizations, and other stakeholders in the survey implementation process through the interpretive guidance process," states Peter Notarstefano, director of home and community-based services with Washington, DC-based Leading Age.

CMS also plans to "develop associated interpretive guidance that will address many of the concerns raised by commenters regarding the actual procedures that will be followed to implement the alternative sanctions," Notarstefano says in a recent posting.