Home Health & Hospice Week

Penalties may close your doors faster than termination, observers warn.

There's no dodging it, but you will have a bit more time to prepare for Medicare's new alternative sanctions policy for home health agencies.

The Centers for Medicare & Medicaid Services finalizes its sanctions policy in the 2013 home health prospective payment system final rule released Nov. 2. In it, CMS hangs onto the penalties it proposed back in July (see Eli's HCW, Vol. XXI, No. 26). They include Civil Money Penalties (CMPs), temporary management, payment suspensions, directed plans of correction, and directed in-service training.

"The alternative sanction rule is one of the most significant changes proposed by CMS in years," says the National Association for Home Care & Hospice.

CMS wants to stagger implementation of the sanctions provisions "because implementation of the complex and far-reaching provisions of this final rule for CMS will require an infrastructure overhaul with changes to current tracking mechanisms and a nationwide training effort to train surveyors, their supervisors and related CMS personnel," the agency says in the final rule. The new effective dates would run from July 1, 2013 to July 1, 2014.

The July 2014 date for application of civil monetary penalties, payment suspensions, and the Informal Dispute Resolution process would be better than the originally proposed November 2013 date, NAHC cheers.

One clarification: CMS clarifies that surveyors will impose sanctions only for condition-level deficiencies, not standard-level ones. Only 260 of more than 11,800 agencies in the program were cited for condition-level deficiencies in 2010, CMS notes in the final rule. "However, there may be occasions where serious noncompliance with a single standard could be cited as a condition-level deficiency, and such a finding could lead to the imposition of a sanction," CMS cautions.

Other provisions in the 2013 HH PPS final rule address:

• M1024. CMS did not give ground on its grouper changes based on diagnosis codes in M1024. The change was one of the most widely protested among the 130+ comment letters submitted on the proposed rule (see Eli's HCW, Vol. XXI, No. 38). Home health agencies can report resolved conditions in the OASIS item for payment diagnosis, CMS allows. They just won't receive case mix points for those conditions reported here.
• Face-to-face. CMS makes some minor changes to who can conduct the face-to-face encounter and label documentation, but falls well short of the sweeping documentation change needed to reduce the F2F burden. "It appears necessary that Congress intervene to bring about any significant changes in the rule," NAHC observes.

Change #1: Under the final rule, CMS is revising regulatory language to make clear that the home health agency, not just the F2F physician, can title the F2F documentation. The documentation "will still require the same content and the certifying physician's signature," CMS explains in the rule.

Change #2: "We will modify the regulations ... to allow [a non-physician practitioner] in an acute or post-acute facility to perform the face-to-face encounter in collaboration with or under the supervision of the physician who has privileges and cared for the patient in the acute or post-acute facility, and allow such physician to inform the certifying physician of the patient's homebound status and need for skilled services," CMS concludes in the final rule.

• Hospice quality data reporting. CMS confirms it is collecting data on two hospice quality measures through 2015 (NQF #0209 and QAPI). Beyond 2015, CMS is still in the decision-making process on what measures to include and when to require data reporting.

CMS continues to consider 2014 implementation of a data collection tool (which some industry members compare to OASIS). And it is eyeing many measures for future inclusion. "We will take these comments into consideration as we further refine the implementation steps and timeline," CMS says