Home Health & Hospice Week

States are dragging their feet on subunits, state licensure changes.

You’ve been working steadily on your Conditions of Participation compliance preparations and feel you’ll be ready when January hits. But an inability to comply may be totally out of your control if your state doesn’t follow suit.

“One of my biggest concerns is that state licensing departments will not be ready,” says consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. “Providers must abide by both state and federal guidelines. If the states do not amend licensure standards to reflect the changes in the new federal CoPs, agencies will be burdened with having to abide by two sets of standards,” Warmack worries.

For example: “The new CoPs do away with the Professional Advisory Group (Professional Advisory Committee),” Warmack tells Eli. “But the state minimum standards currently continue to require this committee with the annual program evaluation. If the state standards are not changed, we will be forced to continue to adhere to a practice which [the Centers for Medicare & Medicaid Services] is now calling a burdensome procedure,” Warmack laments.

The same problem goes for converting subunits to standalone HHAs or branches, says Judy Adams with Adams Home Care Consulting in Durham, North Carolina. “To date, the regional and state offices have not released procedural information for these changes,” Adams notes. “In states where there is a Certificate of Need requirement in place, conversions to standalone agencies could be a long and involved process.”

Frustrating: “The July final rules continues to provide no further guidance on these processes and claims it is outside the rule’s scope,” Adams says. “That means individual states and regional offices will need to address these issues.”

“CMS has not provided so much as a hint as to the process for converting a subunit to a parent HHA or a branch,” says the National Association for Home Care & Hospice. “While NAHC recognized that the responsibility for determining the process for a subunit conversion may be within another division at CMS, the final rule suggests no formalized plan has been set.”

Delay? “In light of the fact that 6 months will not likely be enough time for all subunits to transition, it may be necessary for CMS to further delay that particular provision,” NAHC argues.