Medicare home health agencies: certification process is ineffective in excluding problem agencies : statement of Leslie G. Aronovitz, Associate Director, Health Financing and Systems Issues, Health, Education, and Human Services Division, before the Special Committee on Aging, U.S. Senate

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The Office, 1997 - Medical - 13 pages
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Page 1 - Carolina; the Department of Health and Human Services' (HHS) Office of the Inspector General; and several industry groups.
Page 2 - ... that the HHA is providing or is capable of providing quality care. Moreover, once certified, HHAs are unlikely to be terminated from the program or otherwise penalized, even when they have been repeatedly cited for not meeting Medicare's conditions of participation and for providing substandard care. HHS is charged with ensuring that HHAs meet conditions of participation in the Medicare program that are adequate to protect the health and safety of beneficiaries. As shown in table 1, Medicare...
Page 1 - In summary, we are rinding that Medicare's survey and certification process imposes few requirements on HHAs seeking to serve Medicare patients and bill the Medicare program. The certification of an HHA as a Medicare provider is based on an initial survey that takes place so soon after the agency begins operating that there is little assurance that the HHA is providing or is capable of providing quality care. Moreover, once certified, HHAs are unlikely to be terminated from the program or otherwise...
Page 2 - ... 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 10 - HCFA's criteria for setting survey frequency include many factors, they do not include consideration of whether an HriA is growing rapidly or maintaining a stable level of operations-information state surveyors generally would not have before conducting their survey. New HHAs have the potential for rapid growth and, as a result, are more likely to have difficulties complying with Medicare's conditions of participation. As shown in table 2, we found that nearly one-fourth of the HHAs initially certified...
Page 9 - And, most importantly, not directly surveying branch operations means that quality-of-care issues within an HHA'S overall operations may be missed. When branches have been surveyed because the HHA wanted to convert them to parent offices, significant problems have been found. Several examples follow: In California, surveyers found that one branch of an HHA cared for 581 patients over the 12 months ending September 1996 — more than the average number of patients cared for by an HHA in the state...
Page 5 - Part-time or intermittent skilled nursing services and at least one other therapeutic service (physical, speech, or occupational therapy; medical social services; or home health aide services) must be made available on a visiting basis, in a place of residence used as a patient's home.
Page 2 - Jan. 25. 1999] 484.12 Condition of participation: Compliance with Federal, 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...
Page 9 - ... entire recertification survey of an HHA at a branch office, state surveyors told us that this is seldom, if ever, done. Branch offices typically do not maintain all the personnel files or clinical information that surveyors need in their evaluation. As a practical matter, surveyors told us that they may not have time to conduct home visits with branch office patients and still finish the survey within their allotted time and resources. No Thresholds Exist to Trigger More Frequent Surveys of Rapidly...
Page 6 - ... that they said is not available. Another alternative, also within HCFA'S statutory authority, is to require that HHAS seeking Medicare certification have treated a minimum number of patients. Several HCFA regional offices now suggest that an HHA should have cared for at least 10 patients at the time of its initial survey. However, HCFA central office Page 6 GAO/T-HEHS-97-180 officials said that this would not be a reasonable requirement for all HHAS seeking certification.

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