Home Health & Hospice Week

But surveys will come every 6 months in ‘special focus’ program and alternative sanctions are in the works.

More frequent hospice surveys are off the table, thanks to new legislation signed into law right after Christmas.

Reminder: Early this year, legislators proposed tougher hospice survey procedures in the Helping Our Senior Populations in Comfort Environments (HOSPICE) Act (H.R. 5821) (see HCW by AAPC, Vol. XXIX, No. 6). The legislation came in the wake of two damning 2019 HHS Office of Inspector General reports highlighting severe quality of care problems for hospice patients. One of the HOSPICE Act’s provisions was an increase in routine hospice surveys to every two years.

Now, the COVID-19 relief package signed into law Dec. 27 keeps that frequency at every three years. “We are deeply gratified that the package has been modified to keep routine hospice survey frequency at once every 36 months and instead focuses increased scrutiny on problem providers,” says the National Association for Home Care & Hospice in a message to members.

The new focused scrutiny consists of “a special focus program for enforcement of requirements for hospice programs that the Secretary has identified as having substantially failed to meet applicable requirements of this Act,” the law says. “Under such special focus program, the Secretary shall conduct surveys of each hospice program in the special focus program not less than once every 6 months.”

“NHPCO supports smart oversight when it does not hinder access to high quality care for patients and their families,” the National Hospice & Palliative Care Organization says in a release. “Hospice providers that are following the rules should not be subjected to excessive administrative burden and forced to needlessly divert resources from patient care,” NHPCO President Edo Banach says.

While survey frequency will stay the same, many other things about the survey process will change. Under the law:

• By October 2022 HHS must develop alternative sanctions or “remedies” including civil money penalties, payment suspensions, and temporary management. By that time, HHS also must “develop and implement specific procedures with respect to the conditions under which each of the remedies … is to be applied, including the amount of any fines and the severity of each of these remedies,” the law says.
  Providers have complained that by the time they find out about a survey problem, so many fines have racked up that they can’t possibly dig out of the hole. With that in mind, presumably, the law requires that “such procedures shall be designed so as to minimize the time between identification of deficiencies and imposition of these remedies and shall provide for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies.”