Home Health & Hospice Week

Critical: Do your policies actually reflect your practices?

With resources spread paper thin, home health and hospice agencies may feel like throwing up their hands at the announcement that regular surveys are back in progress.

Reminder: In an Aug. 17 memo, the Centers for Medicare & Medicaid Services directed state survey agencies to resume routine surveys (see Eli’s HCW, Vol. XXIX, No. 31). That includes “onsite revisit surveys, non-immediate jeopardy complaint surveys and annual recertification surveys as soon as resources are available,” according to a CMS release. Plus, they will resolve on-hold enforcement cases.

You can head off potential survey citations by focusing on these hot spots, legal experts advise:

1. Infection control. Medicare surveyors just wrapped up IC-focused surveys of all nursing homes nationwide, CMS says in the release. Some home care providers have reported undergoing IC-centered surveys in recent months too, and you can bet IC will be a major focal point going forward.

From hand hygiene to Centers for Disease Control and Prevention employee screening procedures to Occupational Safety and Health Administration signage to adequate personal protective equipment provision, surveyors are going to home in on a large variety of IC-related compliance issues, predicts attorney Robert Markette Jr. with Hall Render in Indianapolis. “Surveys are back, but these will not be surveys like we knew them,” Markette tells Eli.

IC has always been a highly ranked issue for surveys, but now the emphasis on it will be even heavier, Markette forecasts.

Don’t overlook: It’s not just interactions with patients that will be under scrutiny. IC procedures for office staff, including screening for symptoms, enforcing social distancing, and more will be on surveyors’ agenda, Markette cautions. “It’s a bigger issue than patient safety,” he explains. “It’s staff safety, community safety.”

2. Policies matching procedures. CMS has issued a number of 1135 waivers that have made operating under COVID-19 less difficult, ranging from considering a patient homebound because they have a condition making them susceptible, to contracting the virus, to allowing nurse practitioners, clinical nurse specialists, or physician assistants to order home care and certify patients, to waiving the 30-day OASIS submission requirement.

Agencies must make sure their own policies reflect any changes the agency has adopted due to waivers, Markette urges. If you are adhering to waived regulations but not your own written policies, you’ll still get a citation, he warns.

3. State regulations. In addition to having your practices match your own policies, they must also be allowed under state law. Just because Medicare says it’s OK under a waiver, doesn’t automatically mean your state does, Markette points out.

The bottom line: Check state versus federal versus agency rules and ask — “are they harmonious?” Markette advises.

4. Updates. Make sure your P&Ps match what’s happening now. If you overhauled your written policies back in March and April, check that everything is still in effect now, Markette counsels.

5. Staff education. Not only must your P&Ps reflect current rules and guidance, but your staff need to be able to clearly articulate them as well, Markette says. And their documentation must do the same.

Note: A list of Medicare 1135 waivers for HHAs is at www.cms.gov/files/document/covid-home-health-agencies.pdf and for hospices is at www.cms.gov/files/document/covid-hospices.pdf