Home Health Intermediate Sanctions Timelines and Clarifications
Monday, December 17, 2012
by: VNAA Policy Team

Section: Public Policy and Advocacy

In the Final Home Health Prospect Payment System Rule for Calendar Year 2013 the Centers for Medicare and Medicaid (CMS) adopted changes to the survey and certification process that will allow CMS to impose Intermediate Sanctions on agencies that do not comply with Conditions of Participation (CoP). The final rule modifies the proposed rule in several ways.

Change of Effective Dates

  • Civil monetary penalties, suspension of payment for new admissions and the informal dispute resolution (IDR) process will take effect July 1, 2014.
  • All other changes to the survey and certification process are effective July 1, 2013.
Clarification of Sanctions

Temporary Manager: CMS considers the cost of a temporary manager as allowable on cost reports.

Suspension of Payment: CMS originally proposed that this sanction would suspend payment for existing patients beginning with new episodes of care. That was not included in the final rule as CMS stated this provision would have interrupted care for existing patients.

Civil Monetary Penalties: CMS has added new situations where it would choose a lower range of penalties, specifically in situations where condition-level deficiencies were not directly related to poor quality patient care or were due to one-time staff noncompliance.

CMS also clarified that mid-range penalties can be as low as $1,500 (down from $2,500 in the proposed rule) and will be imposed in instances that did not result in immediate jeopardy for patients health and safety but resulted in poor patient care.

CMS added guidance to the upper level immediate jeopardy penalties ($8,500-$10,000) to ensure the highest possible penalty is not imposed for an isolated violation or one that did not result in actual patient harm. 

Directed Plain of Correction: CMS clarified that this sanction can be imposed if the agency fails to submit an acceptable plan of correction.

Directed In-Service Training: CMS clarified that agencies can select the in-service programs they believe best fit their educational needs.

To read VNAA’s summary of the final rule, please click here.

To download a complete copy of the final rule, please click here.
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