Don’t neglect regulatory issues in an emergency

Industry works with CMS to lighten penalties

Although the safety of employees and patients as well as the resumption of care to patients is a priority for a home health agency following an emergency, don’t forget to address financial and regulatory issues that affect your agency’s operation, says Connie Hetterich, RN, administrator of Sacred Heart Home Care in Pensacola, FL.

"We notified our CMS intermediary that we would be submitting paper claims immediately after the emergency due to lack of electricity and damage to our server," explains Hetterich. Fortunately, CMS [the Centers for Medicare & Medicaid Services] had approved paper claims for agencies affected by the hurricane. We also notified the state licensure agency and our accreditation agency that we had experienced a significant loss of documentation due to the destruction of our building," she says.

This notification is important so that Sacred Heart is not penalized for missing documentation for this time period, she says.

Home health agencies in Florida are experiencing challenges that CMS has not addressed because many of the issues have only recently developed as a result of multiple massive storms, says Gene Tischer, executive director of the Associated Home Health Industries of Florida, the state association for home health agencies in Florida.

His state association, along with the National Association of Home Care and Hospice in Washington, DC, has been working with CMS to address issues such as the financial penalties agencies suffer when patients are evacuated to other areas, which affects claims processing and OASIS (Organization for the Advancement of Structured Information Standards) time frames.

"We have agencies that have missed OASIS collection points and reporting deadlines, so we have asked CMS to provide relief, but until that is given in writing, Florida agencies must do the best they can to meet OASIS mandates," Tischer notes.

Another policy revision that will help home health agencies that experience major disasters and disruption of service is the development of some type of "holding pattern" for patients who are forced to evacuate the service area, he says. "A time frame of up to 30 days could be established during which another home health agency can provide service to the agency and get paid for services performed during the patient’s evacuation, while the initial home health agency can pick up care where it left off before the evacuation," he suggests.

That type of rule would help home health agencies avoid losing revenue when patients leave their service before the completion of episodes of service or before enough therapy visits have been made to meet prospective payment system requirements, Tischer adds.

Another issue the state association is addressing is the development of a process that enables home health agencies to use out-of-state home care nurses to supplement their staff, especially if agency staff are unavailable due to their own personal situation or due to evacuation, he says.

"Out-of-state health workers were allowed to assist Florida agencies, but they had to volunteer their time and work through the Red Cross," Tischer explains. "We need to find a way to allow them to work for pay under the auspices of a Florida provider in the future."

Until emergency rules are put into place, it is important to stay in touch with CMS intermediaries and other regulatory agencies to alert them to problems that your agency may experience in meeting deadlines, he advises.