Home Health & Hospice Week

Will home care providers face the same punishing scrutiny as nursing homes?

The Centers for Medicare & Medicaid Services has signaled that it is trying to get back to business as usual with an Aug. 17 memo directing state survey agencies to resume routine surveys and by proceeding with its plans to reinstate medical review, including taking the Review Choice Demonstration off “pause.” This includes implementing the medical review program in the new states of Florida and North Carolina Aug. 31 (see story, p. 251).

CMS “will resume routine inspections of all Medicare and Medicaid certified providers and suppliers to improve the safety and quality of life of patients and residents,” the agency says in a release. “As CMS resumes some survey and enforcement activities that were previously put on hold, the health and safety of America’s patients will always be our top priority,” CMS Administrator Seema Verma pledges in the release.

Medicare surveyors have spent the past few months conducting infection control surveys of “virtually all nursing homes in the country,” Verma explains. They also made immediate jeopardy-level complaint survey visits.

Now surveyors will resume “onsite revisit surveys, non-immediate jeopardy complaint surveys and annual recerti­fication surveys as soon as resources are available,” according to the release. Plus, they will resolve on-hold enforcement cases.

And: CMS will “temporarily expand the desk review policy, when state surveyors ensure that facilities return back into compliance with Federal requirements without an onsite survey, to include all noncompliance reviews except for immediate jeopardy citations that have not been removed,” the agency says.

Too Soon For Routine Surveys

This will be a big change for home care providers, notes attorney Robert Markette Jr. with Hall Render in Indianapolis. “Home health and hospice were pretty much left alone,” aside from a very few complaint surveys, Markette reckons. “This will be an eye-opener” for home care providers, he expects.

It’s a change that’s coming too soon, legal experts believe. “Although I appreciate CMS’ desire to return survey activities to normal, the reality in our country is that the public health emergency is still ongoing and we continue to see COVID-19 spikes in many areas,” says attorney Matt Wolfe with Parker Poe in Raleigh, North Carolina. CMS should recognize “that non-critical survey activity will deplete resources from health care providers, especially involving smaller and community-based providers. These providers need to be focusing their attention on providing quality care and relieving facilities experiencing surges of COVID-19 patients,” Wolfe tells Eli.

“CMS has done an admirable job of providing regulatory relief to providers during this pandemic,” Wolfe says. “We have to be careful of cutting red tape with one hand and adding red tape with the other.”

Resumption of routine surveys “is premature,” maintains Washington, D.C.-based healthcare attorney Elizabeth Hogue. HHAs are already helping with the overflow of patients choosing home as their setting for care rather than a facility, and that volume may climb. It appears “a number of nursing homes may be on the verge of shutting down,” which will result in more patients being discharged to home, Hogue points out.

In a new survey of long-term care facilities, the American Health Care Association and National Center for Assisted Living found 40 percent of nursing homes surveyed said they won’t be able to sustain operations another six months, and 55 percent are currently operating at a loss.