Home Health & Hospice Week

New rule estimates annual fees totaling $37 million.

You now have even more reason to steer clear of a bad mark on your next survey. One strike and you may have to fork over about $1,600 just for the surveyors' follow-up visit.

The Centers for Medicare & Medicaid Services recently published a proposed rule that would allow the agency to charge survey revisit user fees to health care facilities. Published in the Federal Register on June 29, the rule titled "Establishment of Revisit User Fee Program for Medicare Survey and Certification Activities" proposes the revisit fees for providers cited for deficiencies during an initial certification, recertification or substantiated complaint survey

HHAs in the mix: Home health agencies are subject to the rule. The survey revisit fees would also hit hospices, hospitals and skilled nursing facilities.

Ka-ching: The fees would apply to onsite and offsite (desk) surveys performed to investigate deficiencies. The rule lists the fee for a home health agency onsite revisit as $1,613. CMS arrived at that fee by multiplying a per hour survey cost of $112 by the average HHA survey length of 14.4 hours.

The hospice revisit fee would be a bit higher, $1,736, based on an average visit length of 15.5 hours.

For all health care providers affected, the fee for offsite revisits would be $168.

HHAs accounted for 6 percent of onsite revisit surveys in FY 2006.

CMS says the proposed fees are consistent with President Bush's goals of promoting high quality health care while cutting the federal deficit.

The fees "would affect only those providers or suppliers for which CMS has identified deficient practices and requires a revisit to assure that corrections have been made," states the agency in the proposed rule.

Big conflict: But trade groups representing agencies protest that the rule conflicts with existing law, including a provision of the Social Security Act stating that " ... the Secretary may not impose or require a state to impose any fee on any facility or entity ... for any such determination or any survey relating to determining the compliance of such facility or entity."

Prediction: Fees Likely To Stick

Unusual twist: The statutory authority for the proposed rule is the Department of Health and Human Services' budget for fiscal year 2007, which ends on Sept. 31--about the same time the proposed rule could make it to final form. CMS cannot impose the revisit fees after the September cutoff unless Congress gives its stamp of approval for use of the fees in future fiscal years.

That's likely to happen, says Bob Wardwell, vice president of regulatory and public affairs for the Visiting Nurse Associations of America.

CMS officials "do believe there will be a continued legislative authority and say it is 'in the works,' Wardwell tells Eli.

Others are skeptical that the fees will be approved long term. "User fees have been proposed routinely, but Congress has always rejected them as a cost containment method," says John Beard, president of Alacare Home Health and Hospice in Birming-ham, AL.

Regardless of the chances, stakeholders say they will continue to fight the agency's efforts to forge ahead. In early June, the National Association for Home Care & Hospice, working with other health care provider groups, sent a letter to the House and Senate appropriations chairs and ranking members asking them to prevent CMS from levying and collecting revisit user fees in fiscal year 2008.

Note: Comments on the proposed rule are due by Aug. 27. To read the rule, go to www.gpoaccess.gov/fr/browse.html.