Introduction

10000 – Introduction (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) The Secretary has the responsibility to promote quality of care and the health and safety of patients receiving services through Medicare certified home health agencies (HHA) and hospice programs by ensuring that providers maintain compliance with the Conditions of Participation (CoP). The survey and certification process provides a method for CMS to evaluate HHA and hospice programs’ compliance with the CoPs, ensuring that patient services provided meet the minimum health and safety standards and a basic level of quality. This process is explained in Appendix B of this manual for HHAs and Appendix M of this manual for hospice programs. Chapter 10 provides guidance for the HHA and hospice program enforcement regulations at 42 CFR Part 488. No provisions contained in this chapter are intended to create any rights or sanctions not otherwise provided in law or regulation. In accordance with 42 CFR §488.800 – §488.865 for HHAs and §488.1200-§488.1265 for hospice programs, in addition to termination of the HHA’s or hospice program’s provider agreement, sanctions such as civil money penalties (CMP), suspension of payment for all new admissions, temporary management, directed plans of correction, and directed in-service training can be imposed when an HHA or hospice program are out of compliance with Federal requirements. Alternative sanctions in HHAs and enforcement remedies in hospice programs are recommended by the State survey agency (SA), and the CMS Location reviews the SA recommendation to ensure that it is supported by the SA findings. However, the CMS Location does not have the authority to delegate the imposition of sanctions to the State. It should be noted that failure of CMS or the State to act timely does not invalidate otherwise legitimate survey and enforcement determinations.