Home Health & Hospice Week

Beware: Other alternative sanctions still can shut you down for noncompliance.

Home health agencies hoping to see the CoPs delayed once again were disappointed with a Medicare announcement to the contrary, but it's not all bad news.

In a letter to the National Association for Home Care & Hospice, the Centers for Medicare & Medicaid Services says it thinks one six-month delay was enough for HHAs grappling with Conditions of Participation implementation. CMS will not be delaying CoPs implementation again, sticking with the Jan. 13 start date for the new regulations.

That's despite the fact that the final CoP Interpretive Guidelines are not yet out. CMS issued a draft of the IGs last month, asking for industry feedback. But the guidelines were widely criticized as too vague and lacking critical information (see Eli's HCW, Vol. XXVI, No. 39).

While it won't push the CoPs again, CMS will give HHAs a break on penalties for failing to comply with them. For the first year of CoP implementation, surveyors won't impose CMPs for survey violations, except in Immediate Jeopardy situations, CMS says in the letter to NAHC.

That is a significant concession, because CMPs can quickly close agencies' doors. CMPs as an alternative sanction for HHA surveys took effect in July 2014, and have become an increasingly popular tool wielded by surveyors.

The threat from CMPs rose markedly last year when the CMP amount doubled. In September 2016, the Department of Health & Human Services issued an interim final rule adjusting CMP amounts for inflation. The rule changes the "maximum daily penalty amount for each day a home health agency is not in compliance with statutory requirements" to a whopping $19,787, up from $10,000 previously, HHS specified in the rule published in the Sept. 6, 2016 Federal Register.

At $20K per day, CMPs can quickly put agencies out of business. Even at the previous, much lower levels, CMPs were already closing down HHAs (for two examples, see Eli's HCW, Vol. XXIV, No. 15).

Watch out: While the temporary CMP lift is good news, HHAs still face major problems with CoP compliance. Money penalties are off the table for now, but punishing payment suspensions are not. Surveyors can also still impose the lesser sanctions of Directed Plans of Correction, Directed In-Service Training and Temporary Management.