Prioritizing SA Survey Workload - Initial Surveys and

2008 - Prioritizing SA Survey Workload - Initial Surveys and Recertifications (Rev. 1, 05-21-04) 2008A - Surveys of New Providers and Suppliers (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) New providers/suppliers, including providers/suppliers whose previous Medicare agreement was terminated and are now seeking initial certification, must be in full operation and providing services to patients when surveyed. This means that at the time of survey, the institution must have opened its doors to admissions, be furnishing all services necessary to meet the applicable provider or supplier definition, and demonstrate the operational capability of all facets of its operations. To be considered “fully operational,” initial applicants must be serving a sufficient number of patients so that compliance with all requirements can be determined. A survey evaluates the manner and degree to which the provider or supplier satisfies the various requirements or standards within each condition. Surveyors must directly observe the provision of care and services to patients, and the effects of that care, in addition to interviewing staff and patients and reviewing medical records to assess whether the care provided meets the needs of individual patients and is in compliance with all requirements. Surveyors also review selected provider/supplier policy and procedure documents if needed to support or clarify observations suggesting deficiencies. When the provider/supplier notifies the SA of full operation, the SA documents the file with the date of notification. The SA conducts the survey in a timeframe consistent with CMS policy regarding budget and workload priorities. 2008B - Initial Surveys of HHAs (Rev. 1, 05-21-04) In addition to an onsite survey to determine compliance with the health and safety conditions of participation (CoP), an HHA applicant must now meet capitalization requirements, and complete the enrollment information contained on the Form CMS-855A or CMS-855B, which includes the HHA’s ownership information. Also, the Centers for Medicare & Medicaid Services (CMS) is now requiring each HHA applicant to have provided skilled home health services to a minimum of 10 patients before a survey is conducted. At least 7 of the 10 required patients should be receiving care from the HHA at the time of the initial Medicare survey. 2008D - Effective Date of Medicare Provider Agreement or Approval for Suppliers (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) In accordance with 42 CFR 489.13, the effective date of participation in the Medicare program, i.e. the effective date indicated on the provider or supplier agreement issued by the RO, may not be earlier than the date on which the provider or supplier meets all federal requirements. Federal requirements include, but are not limited to: • Meeting all Medicare enrollment requirements addressed in 42 CFR 424; • Meeting all Medicare provider agreement requirements addressed in 42 CFR 489.10 and 42 CFR 489.12, and; • Compliance with Medicare health and safety standards, i.e., the Conditions of Participation, Conditions for Coverage, Conditions for Certification, or long term care Requirements, as applicable. • For an agreement with a federally qualified health center (FQHC), no survey is required to determine compliance. The effective date is the date on which CMS accepts a signed agreement in which the FQHC attests that it meets all Federal requirements. For FQHCs, the RO uses as the effective date of the supplier approval the date that the MAC indicates it determined that the FQHC’s enrollment application was complete and approvable. • A Medicare supplier approval of a laboratory is effective only while the laboratory has in effect a valid CLIA certificate issued under 42 CFR Part 493, and only for the specialty and subspecialty tests it is authorized to perform. • Other types of providers and suppliers demonstrate compliance with applicable conditions or requirements via a standard survey by the SA (or Federal surveyors/contractors), or by an AO with a CMS-approved Medicare accreditation program. • If on that survey the provider or supplier meets all health and safety standards (including elements, where applicable), then the effective date of the Medicare agreement is the last day of the survey, unless there are other Federal requirements, such as providing evidence of compliance with Civil Rights requirements, that the provider or supplier has not yet met. The date when all other Federal requirements have been met is the effective date of the Medicare agreement. • If on that survey the provider or supplier does not meet all health and safety standards (including elements, if applicable), then, assuming all other Federal requirements have been met, the effective date of the Medicare agreement would be: • For SNFs, the date the SNF has been found to be in substantial compliance with the requirements for participation, and, if applicable, has submitted an approvable waiver request. (See 42 CFR 488.301.) • For non-long term care providers/suppliers, the date when the provider/supplier has: • Met all applicable conditions; or Has been found to be in substantial compliance, but has standard-level (or element-level, where applicable) deficiencies and the RO (in the case of surveys conducted by contractors), SA or AO has received an acceptable plan of correction (POC) and/or CMS receives an approvable waiver request. If a provider or supplier submits both a POC and an approvable waiver request, the later of the dates of the two submissions would be the effective date. 2008E - Administrative Considerations (Rev. 1, 05-21-04) The SA will schedule more frequent surveys and follow-up visits for providers and suppliers with a history of poor performance. Keep in mind geographical considerations and the scheduling of licensure visits and coordinate visits whenever possible. Changes of Ownership (CHOWs) may necessitate adjustment of the survey interval. (See §2702.) 2008F - SA Scheduling of Resurveys (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) Sections 1819(g)(2)(A)(iii) and 1919(g)(2)(A)(iii) of the Act require that each SNF and NF respectively be subject to a standard survey no later than 15 months after the previous standard survey and that the state-wide average interval between such surveys not exceed 12 months. Section 1891(c)(2)(A) requires that each HHA be subject to a standard survey within a 36-month interval. Since the law also prohibits the announcing of such surveys, utilize flexible survey schedules to ensure that these surveys are as “unpredictable” as possible. (Sections 1819(g)(2)(A)(i), 1919(g)(2)(A)(i), and 1891(c)(1) of the Act establish civil money penalties (CMPs) for any individual who notifies a SNF, NF, or HHA of a survey.) A facility should not be surveyed during the same month each year. The SA may conduct surveys of these providers as frequently as it deems necessary, but no more than 15 months after the last standard survey of any SNF or NF, or 36 months for any HHA. In developing the SA survey schedule for HHAs, SNFs, and NFs (at a minimum), the SA utilizes information from SA files, the Online Survey Certification and Reporting System (OSCAR), and other sources at its disposal to identify those providers with poor performance records who should be resurveyed more frequently. Conversely, the SA utilizes the same information to identify those providers that have established a history of good performance, who could be resurveyed less frequently. (See §2702.) For example, the SA may find that some facilities should be resurveyed within 4 months of the prior standard survey, while others may not require a resurvey for up to 15 months from the prior standard survey. The statewide average for SNFs and NFs may not exceed 12 months in a given Federal fiscal year. Schedule surveys to provide a “cushion” against any unforeseeable events, such as staff turnover. Section 1891(c)(2)(B)(ii) of the Act also requires conducting a standard survey (or abbreviated standard survey) of any HHA against which a significant number of complaints have been reported. Sections 1819(g)(2)(A)(iii), 1919(g)(2)(A)(iii), and 1891(c)(2)(B)(i) of the Act also state that such surveys of SNFs, NFs, and HHAs may be conducted within 2 months of any change in ownership, administration, management, and (for SNFs and NFs) director of nursing (DON) to determine whether the change has caused any decline in the quality of care furnished. Based on documented evidence of current accreditation, the SA recertifies accredited entities on a schedule consistent with their accreditation interval. For example, for hospitals, that interval may be only every three years. The timing of the Life Safety Code (LSC) survey is at the discretion of the SA. It may occur before, after, or simultaneously with the health portion of the survey. (See §7410 for more guidance on LSC for SNFs and NFs.)