Home Health & Hospice Week

While officially on the books, the survey consequences of civil money penalties and payment suspensions have been scarce as hen’s teeth, especially for hospices. That’s likely to change thanks to new survey guidance — and soon.

On May 3, the Centers for Medicare & Medicaid Services issued survey memo QSO-24-11-HHA & Hospice, which revises the Medicare State Operations Manual (SOM) chapter 10. The 40-page transmittal contains detailed guidance to State Survey Agencies on when and how to issue alternative sanctions to home health agencies and enforcement remedies to hospices. The document also clarifies procedures for the informal dispute resolution (IDR) process for both types of providers (see story, p. 131).

Background: CMS finalized alternative sanctions for HHAs in a 2012 rule and enforcement remedies for hospices in a 2021 rule, the agency notes in the memo (see HHHW by AAPC, Vol. XXX, No. 42). For the latter, the remedies were part of a larger survey overhaul after high-profile investigations and reports turned up poor quality care that was widely covered in the mainstream media.

Sanctions officially took effect in 2014 for HHAs and remedies in 2022 for hospices, notes the National Association for Home Care & Hospice. But since “CMS had not provided written guidance for surveyors to utilize in applying the enforcement remedies in hospice … they were rarely used,” NAHC notes in its member newsletter.

Now that CMS has issued this guidance, the trade group “anticipates that SAs will begin applying the enforcement remedies and alternative sanctions more than they have in the past,” NAHC cautions.

Timeline: The guidance is effective “immediately,” according to the memo. But SAs have 30 days to communicate the policies to staff, it says.

Watch Out: CMPs Can Reach Nearly $25K Per Day For HHAs, $11K For Hospices

While the name of the consequences evolved over time — from alternative sanctions to enforcement remedies — their content has remained the same. Both HHAs and hospices may be subject to these five sanctions/remedies:

• Civil money penalties;
• Suspension of payment for all new admissions;
• Temporary management;
• Directed plan of correction; and
• Directed in-service training.

Maximum CMPs can reach nearly $25,000 per day for HHAs and close to $11,000 per day for hospices under 2023 updates. Those steep penalty amounts make CMPs the sanctions that providers probably fear most.

Payment suspensions for new admissions run a close second, however, compliance experts point out.

Don’t forget: Agencies deemed by accrediting organizations aren’t in the clear on the new penalties. “AOs are not authorized to impose federal sanctions/remedies,” CMS acknowledges in the memo. But “a deemed HHA or hospice program loses its deemed status when a condition-level finding is cited on a complaint or validation survey,” the agency explains.

When that happens, “the CMS Location returns oversight of the accredited HHA or hospice program back to the SA until the HHA or hospice program can demonstrate compliance with the [Conditions of Participation],” CMS elaborates. “During the time that the SA has jurisdiction over the HHA or hospice program, the SA, not the Accrediting Organization (AO), will follow the procedures for recommending the imposition of sanctions/remedies, if appropriate.”

Note: The survey memo is at www.cms.gov/files/document/qso-24-11-hha-hospice.pdf. The CMP adjustment chart with penalty amounts is at www.cms.gov/files/document/ltc-hha-clia-hospice-specific-cmp-adjustments-2023.pdf.