Clarification Needed on Recent Enforcement and Certification Proposals

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

CMS Enforcement Home Health ComplianceIf recent CMS enforcement proposals are accepted without changes, the impact on home health agencies (HHAs) could be significant. Monetary penalties for non-compliance could be applied before an agency is given time to correct the deficiency, and immediate jeopardy citations could be applied inconsistently, resulting in unfair negative publicity for some HHAs.

In a letter dated Sept. 4, 2012, the American Hospital Association (AHA) urged changes to the proposed rules, which could affect care transitions. Although the association supports the idea of informal dispute resolution (IDR) for home care agencies, it’s troubled that CMS does not plan to delay the onset of penalties upon request of IDR.

“It also concerns us that the language of the proposed regulation does not require a timetable for CMS or the state to provide IDR,” writes Rick Pollack, executive vice president of AHA, which recommends requiring CMS or states to provide IDR within 15 days to any agency that makes the request.

Pollack also wants CMS to give home health agencies time to correct deficiencies before implementing civil monetary penalties or suspending payment. “The process of making a citation can be subjective, and what may be intended as a fine for HHAs could put some small HHAs in financial jeopardy,” he writes. The AHA asked CMS to revise the way immediate jeopardy citations are handled to ensure that criteria are applied consistently and fairly.

In the same letter, the AHA stated concerns about CMS’s proposed minimum qualifications for surveyors, which require only the CMS-sponsored Basic HHA Surveyor Training Course and its prerequisites. The association is disappointed that the proposed minimum qualifications don’t describe a basic set of required knowledge (e.g., clinical experience and familiarity with the home health care delivery system). The AHA asked CMS to explain how it will ensure that surveyors possess consistent levels of competence, knowledge, and skill, as well as initial/ongoing training requirements for surveyors.

I’ll continue to update you on these proposals requiring home health compliance as they move through CMS’s commenting and revisions process.

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