FREQUENTLY ASKED QUESTIONS FROM THE WEBINAR

Compliance Highlights in Home Health by ARLENE MAXIM, RN

Vice President of Program Development for Quality in Real Time (QIRT)

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FAQ

Home health is one of the most intensely regulated industries in the U.S. And in 2017, it’s going to take a lot of effort on the part of agency leadership just to keep up.

In this document, renowned home health consultant Arlene Maxim, RN answers questions asked in her recent webinar, Compliance Highlights in Home Health: Where to Focus to Keep Your Agency Successful. This webinar is available for on-demand viewing now at kinnser.com/focus.

SECTION 1: QUESTIONS ABOUT EFFECTIVE COMPLIANCE PROGRAMS

TOPIC: Compliance programs vs. QAPI programsQ: Is the compliance program described in the OIG's Seven Elements of an Effective Com-pliance Program the same thing as the Quality Assurance and Performance Improvement (QAPI) Program?

ARLENE MAXIM, RN: No, the compliance program described by the Office of Inspec-tor General (OIG) is looking for compliance with a written program that unique to your agency, regarding ethical financial, employment, and administrative issues, etc. There may be some crossover between this program and QAPI, but they are clearly completely different responsibilities.

TOPIC: Compliance officers & committeesQ: Should the compliance committee consist of multiple disciplines?

ARLENE MAXIM, RN: Yes, the compliance committee should include leaders from your agency’s board, administration, billing staff, coding staff, and quality assurance (QA). The compliance committee is different from a professional advisory committee (PAC). The compliance committee will look at complaints by staff and/or patients and look for any signs of fraud or abuse, i.e. it will review PEPPER reports, CASPER, etc., and write a formal report for the compliance officer to submit to the board on a regular basis.

Q: The requirement to have a compliance officer has existed in my state for a long time and is part of state licensing requirements. How is this new regulation different?

ARLENE MAXIM, RN: Not all states are licensed, and not all licensing requires a com-pliance officer. You should need to do a gap analysis comparing the OIG requirement to your state requirement. They may be similar, but do not assume that they are the same.

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Q: In my hospital-based home health agency, we have a global compliance program with a compliance officer. We are accountable to them just as the hospital is. Is this OK?

ARLENE MAXIM, RN: This should be OK as long as the home health agency is specifically considered in the design of the compliance program. Be sure to study the Conditions of Participation (CoPs), and look for any possible gaps in compliance assessment that the hospital might miss.

Q: Can the agency compliance officer be the agency ad-ministrator? The director of nursing? The HR manager? In small agencies, there aren’t many options.

ARLENE MAXIM, RN: You are right – there aren't many options at small agencies. The compliance officer has to be someone neutral in decisions about com-pliance. It would be much easier for the HR person to fit that role than an administrator or director. For instance, termination of an employee for not following policy would be an HR job, so out of your specific choices, HR might be the best one. At the end of this FAQ, there is a sample compliance officer job descrip-tion that might help identify the correct staff member.

Q: Is the compliance committee the same as the profes-sional advisory committee or board?

ARLENE MAXIM, RN: No, it is not. The commit-tee will be strictly looking at compliance issues — not overall agency issues like the PAC. As of July 13, you will no longer need a PAC. Also, there are NO writ-ten requirements as to who actually serves on the compliance committee. For instance, currently on the PAC, we need to have a physician, a registered nurse, and all disciplines. This is not so for the compliance committee. See my previous response about multiple disciplines.

Q: What are the required qualifications for the compli-ance officer?

ARLENE MAXIM, RN: There is no degree (i.e. RN, JD, etc.) attached to the requirement for a compliance officer. However, you must have an employee designat-ed as responsible for the agency’s compliance efforts. The compliance officer must have authority, they must have support of the board, and they should have direct access to the board.

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TOPIC: Internal monitoring & audit-ingQ: Regarding Element #6 Conducting Internal Moni-toring and Auditing, what types of changes are need-ed in contracts?

ARLENE MAXIM, RN: When you read the CoPs, you will find that all staff (direct and con-tract) have the responsibility for a number of things — including but not limited to providing the Bill of Rights statement at the required time frames, coordination of services and responsi-bilities, etc. I would highly recommend that you carefully review all contracts for compliance and revise as necessary. The surveyors will be re-viewing them.

SECTION 2: QUESTIONS ABOUT THE NEW CON-DITIONS OF PARTICIPATION (CoPs)

TOPIC: CoPs - Patient RightsQ: Where can we find the guidelines for revising our patient rights and responsibilities?

ARLENE MAXIM, RN: In the new CoPs. It’s a 370+ page document in the Federal Register here: https://s3.amazonaws.com/public-inspec-tion.federalregister.gov/2017-00283.pdf

Q: Can written and verbal patient rights and re-sponsibilities be given on the same day, like during the initial visit?

ARLENE MAXIM, RN: That is a very good question, and there is nothing in the new Condi-tions indicating you cannot, but that is a lot of in-formation to go through during an initial visit. The Conditions indicate that they want the clinician to spend time going through the Conditions with a “responsible party” and/or the patient. The in-terpretive guidelines will provide more direction. Right now, we can only guess as to what they are looking for at each review.

TOPIC: CoPs - Board of Directors Q: Aren't board members usually on salary?

ARLENE MAXIM, RN: Not necessarily, unless they are an employee of the agency. For instance,

many organizations have an administrator on the board. In most agencies (unless they are large companies) the board is made up of owners and managers with no salary identified with the board membership. You must, however, have a board of directors (or governing body) at all times over-seeing the agency. That has been a law since the inception of home health care through the CoPs.

Q: What if your agency is too small to pay board members?

ARLENE MAXIM, RN: Small agencies are, as explained earlier, made up of owners and, possi-bly, some management staff. Just remember, if you take on a board position, every member is legal-ly and financially responsible for everything that goes on in the agency. Most boards with small agencies are not paid.

Q: Do board members have to be licensed in the state we practice?

ARLENE MAXIM, RN: No. It would be nice to have more objectivity by utilizing people from outside our agency. You can have outside board members. Just remember that they have to fol-low policy and are legally and financially beholden to the agency.

Q: How many members should we have on the board?

ARLENE MAXIM, RN: There is no require-ment. I’ve seen agencies where the owner is the only board member. I do not recommend that. Our recommendation is at least two but no more than five.

Q: What if the board members are the owner/CEO/administrator and the compliance officer? This is very common in smaller agencies.

ARLENE MAXIM, RN: Owner, CEO, and ad-ministrator is okay, but the compliance officer should not be a member of the board. The com-pliance officer should be a separate person re-porting to the board.

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NOTE: On March 31, 2017 CMS postponed the effective date of the new home health CoPs from July 13, 2017 to January 13, 2018.

TOPIC: CoPs - Discharge PlanningQ: Can the discharge summary be the assessment?

ARLENE MAXIM, RN: The assessment would be part of the discharge summary, but it clearly does not include all of the seven elements listed in the presentation.

Q: Who do we send the discharge summary to?ARLENE MAXIM, RN: You need to send the discharge summary to the hospital, ER, or nursing home, etc.

Q: If a patient is discharged to their home, who would it go to? The physician? The clinic?

ARLENE MAXIM, RN: I am assuming that this question is being asked relative to a patient in an AFC or assisted living. In that case, you would send to the physician and/or clinic. Again, we will get more information as Interpretive Guidelines are issued.

TOPIC: CoPs - Clinical ManagerQ: Is the new clinical manager role in addition to the director of nursing?

ARLENE MAXIM, RN: No, it is a re-naming of the “supervising nurse” in the previous CoPs. There are different qualifications and some differ-ent duties. It is not an additional person.

TOPIC: CoPs - General QuestionsQ: I have a non-Medicare home health agency, do the CoPs affect my agency?

ARLENE MAXIM, RN: If you are ‘certified,’ then yes. The CoPs state the following: Section 1861(o) of the Act describes an HHA for purposes of participation in the Medicare program. All the requirements are stated generally, and are applicable to the HHA’s overall activity, not specifi-cally to Medicare patients. This provision, which was reaffirmed by the Congress in the Omnibus Bud-get Reconciliation Act (OBRA), 1987 amendments to section 1891(a) of the Act, has been in the law since the inception of the Medicare program, and CMS’ interpretation of it has remained the same. Under section 1891(b) of the Act, the Secretary is

responsible for assuring that the CoPs, and their en-forcement, are adequate to protect the health and safety of individuals under the care of an HHA, and to promote the effective and efficient use of Medi-care funds. To implement this requirement, State Survey Agencies and CMS-approved accrediting or-ganizations conduct surveys of HHAs to determine whether they are complying with the CoPs.

Q: Will my board be required to be more involved, like Medicare agencies?

ARLENE MAXIM, RN: If you are a certified agency and have a provider number for Medicare or Medicaid, yes.

Q: Where can I get the new CoPs? ARLENE MAXIM, RN: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-00283.pdf

Q: You said these are effective in July, but some parts are not finalized?

ARLENE MAXIM, RN: The only ‘non-finalized’ issue is the discharge/transfer summary require-ment that is part of the IMPACT Act. There are still parts of the CoPs that have discharge/trans-fer requirements. All others are effective July 13, 2017. There are parts of the QAPI program that will be required in 2018, but the guidance has not been made clear. We will need to watch for the Interpretive Guidelines to get more information on all of this.

Q: Which items are certain and which are subject to change?

ARLENE MAXIM, RN: The only one that is ‘subject to change’ would be the discharge/trans-fer items since we don’t have the final rule yet, but I don’t anticipate any changes being made.

Q: When do the new CoPs go into effect? ARLENE MAXIM, RN: July 13, 2017

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NOTE: On March 31, 2017 CMS postponed the effective date from July 13, 2017 to January 13, 2018.

NOTE: On March 31, 2017 CMS postponed the effective date from July 13, 2017 to January 13, 2018.

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SECTION 3: PROFESSIONAL ADVISORY COMMITTEES (PACs)

Q: Are professional advisory committees (PAC) going away? ARLENE MAXIM, RN: Yes, starting July 13, 2017, but not before. Do not dismantle your PAC yet.

SECTION 4: 30-DAY EPISODES

Q: When is 30-day billing going to start? ARLENE MAXIM, RN: There has been no date set. CMS said “in the summer.” All indications are that the 30-day episode will happen. We will need to wait for more direction. This will occur around or at the sametime therapy case mix is eliminated.

Q: Was any consideration given to the increased burden on physicians for episodes of 30 instead of 60 days? It will double the paperwork they have to complete!

ARLENE MAXIM, RN: Nothing is documented regarding this. This is not part of the CoPs. This is part of the “Home Health Payment Groupings Model.”

Q: So will we be required to do an OASIS every 30 days? Or will we just bill every 30 days like hospice does? ARLENE MAXIM, RN: You will be required to complete OASIS. Data relative to re-certifications will shoot up. Watch your PEPPER reports!

Q: On the episodes moving from 60 days to 30 days, does this mean recertification every 30 days? ARLENE MAXIM, RN: Yes, it does.

ABOUT KINNSER

Kinnser creates the software solutions that power post-acute care. From its headquarters in Austin, Texas, Kinnser leads the industry by consistently delivering the smartest, most widely used solutions for home health, private duty home care, therapy and hospice. With an enduring focus on customer success, Kinnser helps post-acute care businesses reduce expenses, increase revenue, streamline processes and improve care. For more information, visit kinnser.com or call toll free 877.399.6538.

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About the authorArlene Maxim, RN is Vice President of Program Development for Quality in Real Time (QIRT) based in Floral Park, New York. Arlene has served in various capacities from home care administrator to home care agency owner and home care consultant. She has designed and implemented management and educational programs for non-profit, hospital-based, and for-profit certified home care agencies. Arlene is a popular speaker at educational programs related to OASIS, coding, clinical documentation, home care start-up, as well as a variety of other topics. Arlene is also the Vice Chair of the Association of Home Care Coding & Compliance (AHCC).

FAQ: COMPLIANCE HIGHLIGHTS 5

Sample Job DescriptionCOMPLIANCE OFFICERReporting to: Agency AdministratorStatus: Non-ExemptSupervises: None

GENERAL DESCRIPTION OF RESPONSIBILITIESThe Compliance Officer is a qualified person appointed by the Administrator to ensure the man-agement and employees are in compliance with the rules and regulations of the agency. He/she is authorized to review and evaluate compliance issues/concerns within the organization. He/she functions under the direction of the Agency Administrator.

DUTIES: 1) Performs the duties of a Compliance Officer. 2) Participates in the development of personnel policies and procedures that are de-

signed to attract, retain, and motivate staff. 3) Assists Agency Administrator in selection, orientation, direction, and evaluation of staff. 4) Participates in the development of short- and long-range planning based on Agency

goals and objectives. 5) Promotes an effective system of communication throughout the Agency. Informs the

staff of any changes in Agency’s policies and procedures, CEO memos, announcement of scheduled meetings, continuing education teleconference, and webinars.

6) Participates in processing of patient billing. Ensures that patient records are complete with all necessary documentation included in the chart prior to the submission of billing.

7) Represents Agency in the community, health care groups, and participates in local and regional health promotion, awareness, and disease prevention programs.

8) Maintains and enhances professional expertise through education and participation with various health and business organizational activities.

9) Stays informed about third party new regulations pertaining to home health service, compliance, confidentiality, and personnel.

10) Coordinates with Director of Clinical Services in transmission of the OASIS report to the state.

11) Oversees updating and the implementation of the Agency’s privacy/ confidentiality, and compliance policies and procedures, protocols. Provides staff with informational reports and conducts annual training (video presentation that includes pre and post test). Ensures and monitors staff compliance and reports to the Administrator any deficiencies found.

12) Coordinates with legal counsel/consultants and members of the Agency’s Administra-tion to achieve and maintain compliance with all applicable regulatory requirements.

13) Identifies and reviews those companies who conduct business with the Agency and ensures that there is a “Business Associate Agreement” contract that complies with

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regulations.14) Performs periodic monitoring and updating of appropriate administrative, technical,

and physical safeguards to protect the privacy of the Agency’s protected health infor-mation.

15) Attends educational seminars concerning privacy rule, applicable state law, and any developments that relate to the Agency's operation.

16) Performs other duties as assigned by the Agency Administrator.

CRITICAL DEMANDS 1) Visual/hearing ability sufficient to comprehend written/verbal communication. 2) Ability to perform tasks involving physical activities, which may include heavy lifting. 3) Ability to deal effectively with stress.

QUALIFICATIONS 1) Bachelor’s degree preferred. 2) General working knowledge and ability to use various office machines. 3) Computer literate and able to type 40-50 words per minute. 4) General knowledge of business principles and management.

AGREEMENTI have read and understand the job description of the Compliance Officer. I am able to perform all the functions described in the following areas: General Description of Responsibilities, Duties, and Critical Demands. Furthermore, I meet all requirements in the Qualifications list.

____________________________________ ________________Employee’s Signature Above Printed Name Date

____________________________________ ________________Supervisor’s Signature Above Printed Name Date

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FAQ: COMPLIANCE HIGHLIGHTS 7