Home Health & Hospice Week

Warning: Learning curve likely steep.

Although it may not always feel like it, many states have been enjoying a survey “honeymoon” since the drastically revised Home Health Conditions of Participation took effect in January. Now that respite is over.

Why? The Centers for Medicare & Medicaid Services issued the final Interpretive Guidelines for the new CoPs right before Labor Day weekend. Home health agencies had criticized CMS for not issuing final IGs by the time the CoPs took effect on Jan. 13, but CMS insisted that IGs “do not drive the citation of non-compliance. That can only be done based upon the regulation itself” (see Eli’s HCW, Vol. XXVII, No. 3). Accordingly, CMS refused requests to postpone the CoPs’ implementation date until the final IGs were issued.

While CMS held the line on the CoPs’ effective date, surveyors in many states chose to prioritize other provider types’ surveys first, industry veterans tell Eli. According to CMS’s CASPER data reported as of Aug. 27, surveyors have conducted 2,159 HHA surveys so far in 2018.

In addition to this “back-burnering” of home health agency surveys, surveyors also may have given agencies the benefit of the doubt on gray areas in the new CoPs, experts say.

Change: Now, “the honeymoon is over,” expects attorney Robert Markette Jr. with Hall Render in Indianapolis. “With the final IGs out, we’ll start seeing surveys ramp up.”

Bad: HHAs will have a “difficult” six months to a year as surveyors increase HHA survey frequency and agencies figure out the practical application of the new and revised CoPs, Markette expects. Agencies will work through the survey process under the new CoPs and “learn a lot,” he predicts.

Good: Going through the actual surveys, we “will find out in a much more concrete fashion what the CoPs mean,” Markette says. Then agencies can modify their practices to be in compliance with the new rules.

And thankfully, HHAs have a little bit of breathing room in which to ramp up, since CMS suspended Civil Money Penalties for the first year of the new CoPs. That means punishing CMPs won’t apply until January (see Eli’s HCW, Vol. XXVI, No. 43). At up to $20K per day, CMPs can quickly put agencies out of business.

Take These 3 Steps Toward CoP Mastery

Now that the final IGs are finally out, Markette recommends HHAs:

1. Read the IGs. Analyze what has changed between the draft and final versions, as well as from the old CoP IGs.

2. Revise P&Ps. If you based your current policies and procedures on the draft IGs issued last fall, you may need to change some of them. For example, the final IGs have loosened up the restrictions on what duties home health aides may perform in relation to medication, compared to the draft IGs.

3. Train staff. Once your P&Ps are set, educate your staff on the new procedures.

Note: See the new final IGs at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-25-HHA.pdf.