Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies

Front Cover
William J. Scanlon
DIANE Publishing, 1999 - Medical - 48 pages
Addresses concerns about the rapid growth in the number of certified home health agencies (HHA) certified to care for Medicare beneficiaries & the effectiveness of the survey & certification process. Becoming a Medicare-certified HHA is relatively easy -- probably too easy, given the large number of problem agencies identified in various recent studies. This report determines how the Health Care Financing Admin. (HCFA): controls the entry of HHAs into the Medicare program, & ensures that certified HHAs continue to comply with Medicare's conditions of participation & associated standards. Also looks at HCFA's process for decertifying HHAs.

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Page 30 - State, and local laws, disclosure and ownership information, and accepted professional standards and principles. (a) Standard: Compliance with Federal, State, and local laws and regulations. The HHA and its staff must operate and furnish services in compliance with all applicable Federal. State, and local laws and regulations. If State or applicable local law provides for the licensure of...
Page 6 - Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies" (GAO/HEHS-9829), it has been rare for a home health agency not to meet Medicare's three fundamental certification requirements: 1) being financially solvent; 2) complying with Title VI of the Civil Rights Act of 1964, which prohibits discrimination; and 3) meeting Medicare's conditions of participation. The GAO report concluded that "home health agencies self-certify their solvency, agree to comply with...
Page 40 - Comments From the Health Care Financing Administration DEPARTMENT OF HEALTH & HUMAN SERVICES Health Care financing Administration The Administrator Washington, DC 20201 DATE: MAY 30 2000 TO: Leslie G.
Page 1 - The Honorable Charles E. Grassley Chairman The Honorable John B. Breaux Ranking Minority Member Special Committee on Aging United States Senate The...
Page 30 - ... guardian regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the patient's property by anyone furnishing services on behalf of the HHA, and must document both the existence of the complaint and the resolution of the complaint.
Page 4 - Alternatively, HHAs may elect to be surveyed and accredited by either the Joint Commission on the Accreditation of Healthcare Organizations or the Community Health Accreditation Program. HHAs that are surveyed according to the CMS-prescribed survey frequency by either of these accrediting bodies and pass their surveys are "deemed
Page 1 - A, the claimant can seek reconsideration by the Health Care Financing Administration (HCFA) in the Department of Health and Human Services.
Page 15 - ... had no system in place to ensure that its contractor staff had the appropriate qualifications and licenses. Similarly, a branch office of a Massachusetts HHA had cared for 69 patients since the HHA'S last survey. The branch was denied initial certification as a parent office because it failed to meet nine standards associated with several conditions of participation. For example, the surveyors found that the branch office, in 10 of 12 cases examined, did not follow the plan of care and provide...
Page 28 - When this occurs, the Department of Health and Human Services' (HHS) Office of the Inspector General (OIG) is responsible for determining whether such circumstances warrant prompt nationwide exclusion of those providers from all federal health programs.
Page 44 - A home health agency must provide at least one of the qualifying services directly through agency employees, but may provide the second qualifying service and additional services under arrangements with another agency or organization.

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