Medicare Compliance & Reimbursement

As always, the Medicare program will retain its ability to terminate home health agencies for noncompliance with the Conditions of Participation (COPs). But if the new alternative sanctions proposal is finalized, surveyors will also wield these tools when they find condition-level or repeated deficiencies:

• Civil Money Penalties. Surveyors can impose CMPs on a per instance or per day basis. Fines will range from $500 to $10,000 per day or instance. HHAs can appeal the CMPs, but will receive a 35 percent lower CMP rate if they forego an appeal. CMPs will begin accruing on the date of the survey and will be due 15 days from the final administrative notice of the penalties, the Centers for Medicare & Medicaid Services says in the 2013 home health prospective payment system rule published in the July 13 Federal Register.
• Temporary management. A CMS representative or CMS "authorized agent" would be appointed. The HHA will pay the new manager's salary directly.
• Payment suspension. CMS would be able to impose payment suspensions for new admissions and new episodes. HHAs would not be eligible for repayment after correcting the deficiencies.
• Directed plan of correction. CMS or the temporary manager would develop specific POC actions, which would include patient outcomes and deadlines.
• Directed in-service training. Training would be based on staff's "lack of knowledge" that led to a deficiency and would retrain "the staff in the use of clinically and professionally sound methods to produce quality outcomes," the rule says.