Home Health & Hospice Week

2 more sanctions are waiting in the wings for next year’s implementation.

Get to know the new alternative sanctions surveyors have at their disposal before you find them imposed on your agency.

Here are the new sanctions for July 2013, which Medicare may impose individually or together:

• Temporary management. A Centers for Medicare & Medicaid Services representative or CMS "authorized agent" will be appointed. The HHA will pay the new manager’s salary directly. In the HHPPS final rule, CMS clarifies that "the HHA’s governing body must ensure that the temporary manager has authority to hire, terminate or reassign staff, obligate funds, alter procedures, and manage the HHA to correct deficiencies identified in the HHA’s operation."

• Directed plan of correction. CMS or the temporary manager must develop specific POC actions, which would include patient outcomes and deadlines.

• Directed in-service training. Training will be based on staff’s "lack of knowledge" that led to a deficiency and would retrain "the staff in the use of clinically and professionally sound methods to produce quality outcomes," the rule says.

In July 2014, surveyors will begin using two new sanctions that HHAs fear could close their doors quicker than termination:

• Civil Money Penalties. Surveyors will be able to impose CMPs on a per instance or per day basis. Fines will range from $500 to $10,000 per day or instance.

• Payment suspension. CMS will be able to impose payment suspensions for new admissions, but not new episodes as originally proposed. HHAs will not be eligible for repayment after correcting the deficiencies.

In choosing sanctions, surveyors will rely on the following six factors, CMS says in the rule:

1. Whether the deficiencies pose immediate jeopardy to patient health and safety;

2. The nature, incidence, degree, manner, and duration of the deficiencies or noncompliance;

3. Repeat deficiencies, the HHA’s compliance history in general, and specifically with reference to the cited deficiencies, and any history of repeat deficiencies at either the parent or branch location;

4. Whether the deficiencies are directly related to a failure to provide quality patient care;

5. Whether the HHA is part of a larger organization with documented performance problems;

6. Whether the deficiencies indicate a system-wide failure of providing quality care.