Home Health & Hospice Week

Expect sanctions at resurvey time.

Three of the five new alternative sanctions for home health agency surveys are now in effect, but you wouldn’t know it. That’s because surveyors have yet to use them.

"As far as I know, nobody has implemented them yet," a Centers for Medicare & Medicaid Ser-vices official said of temporary management, directed plans of correction, and directed in-service training at a recent industry conference. The sanctions were approved for July implementation in the 2013 home health PPS rule. Next summer the more drastic civil money penalties and payment suspensions will take effect, as well as informal dispute resolution (IDR).

Surveyors may be holding off on using the sanctions because CMS has yet to issue official regulations, guidance and survey protocols on choosing and implementing sanctions. Those documents are in the final clearance process, said CMS’s Pat Se-vast at the National Association for Home Care & Hospice annual meeting in Washington, D.C.

Or it may be because those lesser sanctions will not get much play. About 18,000 nursing homes receive state surveys every year, and surveyors only imposed those sanctions less than once a year, Sevast estimated in the Nov. 1 session. "In the nursing home world, these three sanctions are rarely used."

For HHAs, about 5,000 agencies will receive surveys once every three years and a good amount of those surveys will be deemed (and thus exempt from sanctions), Sevast related. So you can expect the temporary management, directed training, and directed plan of care measures to see even less use.

What To Expect In The Next Round

Don’t expect surveyors to be so shy about using the sanctions taking effect next July — CMPs and payment suspensions for new admissions. State surveyors will be imposing these sanctions in lieu of immediate termination, Sevast said.

Think of it this way: Currently, home health agencies are on a 90-day termination track if they don’t correct condition-level deficiencies, Sevast noted. Alternative sanctions will give them a longer period of time — up to six months — to fix things before termination.

Prediction: Sevast expects to see surveyors impose alternative sanctions starting with the revisit survey, not the initial survey that finds the condition-level deficiencies. If deficiencies are not corrected, surveyors will sometimes reach for these tools rather than go straight for termination, she forecasts.

It’s up to the State Survey Agency and the CMS Regional Office to determine whether to use sanctions, Sevast said. The SA and RO will be using a revised tracking system in ASPEN called AEM to manage the sanctions. The system revisions will be ready for testing by February for Spring 2014 implementation and surveyor training.

You can also expect to see the per day penalties used much more often than the per instance ones, Sevast says. Either way, combined CMPs can’t exceed more than $10,000 per day.

Additional changes: Currently, six states already furnish an IDR process for HHAs. That will go nationwide this summer for condition-level deficiencies, Sevast noted. (See a future issue of Eli’s Home Care Week for more information on the forthcoming IDR option.)

Another survey change will be introduction of the abbreviated standard survey for complaints, changes in ownership, and reactivating billing privileges, Sevast reminded attendees.

The abbreviated survey is "less than a standard survey" and focuses on specific issues, Sevast said. Complaint surveys will focus on the allegations in the complaints; CHOW surveys will focus on management, supervision and operations areas; and reactivation surveys will focus on operations, coordination and quality of care, and plan of care areas.

Note: The final rule containing the alternative sanctions provision is at www.gpo.gov/fdsys/pkg/FR-2012-11-08/pdf/2012-26904.pdf.