To protect themselves against the Centers for Medicare & Medicaid Services’ compliance enforcement mechanisms, home care providers must focus on quality assessment and performance improvement (QAPI) programs, experts at the National Association for Home Care & Hospice said during a webinar Tuesday.
“It’s very, very important that you spend the resources necessary to develop your QAPI program,” Wehri said.
Earlier this month, the Centers for Medicare & Medicaid Services released updates to its enforcement remedies and alternative sanctions for home health and hospice agencies. These remedies and sanctions may be imposed in lieu of termination for providers with condition-level deficiencies. They include civil money penalties, payment suspensions, temporarily-appointed management, directed plans of correction or in-service training.
“Anytime you have condition-level deficiency, [your] organization is on track for termination from the Medicare program,” Katie Wehri, NAHC’s director of regulatory affairs, stressed during the webinar. “What these alternative sanctions and remedies are intended to do is to be put in place instead of terminating the hospice or home health agency.”
In determining whether a noncompliant agency is fit for sanctions or remedies, CMS will consider whether there is evidence of a self-regulating QAPI program, Wehri said. A QAPI program is valuable evidence showing an organization is focused on care quality, she noted, which may affect how sanctions are applied in the event of noncompliance.
She added that CMS will also consider the broader context surrounding a condition-level deficiency. CMS will take into account the type of condition-level deficiency, its effect on patient care and more when making a determination.
“CMS has said that the remedies should be used by considering the level of degree of harm that is occurring in the organization,” Wehri said. “They’ll consider the context behind the noncompliance — whether it’s patient-related or more administrative-related — and they will use the type of enforcement that has the best chance of the facility, meaning the home health or hospice agency, achieve future compliance.”
