Organization of HHA

2182 - Organization of HHA (Rev. 125, Issued: 10-31-14, Effective: 10-31-14, Implementation: 10-31-14) It is permissible for an HHA to be located at a single site or have a parent site with services available at other approved locations, unless prohibited by State law or regulation. If there is more than one site, there must be a designated parent site with any other designated sites (branches and/or subunits) being part of that agency as described in more detail below. The parent, branch or subunit must be operational during normal business hours as defined by the parent or subunit. Subdivisions A subdivision is a component of a multi-function health agency, such as a hospital-based HHA or the nursing division of a health department, which independently meets the CoPs for HHAs. A subdivision would need to meet all requirements for the initial survey including completing the CMS Form-855A and having this form verified by the assigned MAC. A subdivision may have subunits and/or branch offices and, if so, is regarded as a parent agency. Parent HHA The parent HHA is that part of the HHA that develops and maintains administrative control of all approved locations. The parent is listed on the Medicare Enrollment Application (Form CMS -855A.) The parent HHA is responsible for all services provided at the parent and those provided at any of its approved branch locations. The parent HHA must also submit any relevant updates for all approved locations on the Form CMS-855A. Branch Offices A branch office is a location or site from which an HHA provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the HHA and is located sufficiently close to the parent agency so that it shares administration, supervision, and services with the parent agency on a daily basis. The branch office is not required to independently meet the CoPs as an HHA. When the surveyor is conducting a survey of an HHA with branch offices, ascertain from HHA records whether the branch offices are provided adequate supervision by the parent agency and whether they are, in fact, sufficiently close to the parent agency to be considered branch offices rather than subunits. If this judgment cannot be made without direct observation, the surveyor should visit the branch office to make this determination. When reviewing records and conducting visits to patients’ homes, the surveyor selects some records and/or schedules some home visits to patients who are served by each branch office. The surveyor may also conduct a standard survey of the HHA at a branch office. When conducting a survey at a branch, the surveyor may request that all necessary documentation for review be transported to the branch. This may include, but not be limited to, a sample of clinical records from the parent and any other branches, governing body minutes, personnel records, etc. Subunits A subunit is associated with the parent HHA but is a semi-autonomous organization that: (1) Serves patients in a geographic area different from that of the parent agency; and (2) Must independently meet the conditions of participation for HHAs because it is too far from the parent agency to share administration, supervision, and services on a daily basis. The standards on governing body, administrator, and under the circumstances noted here, the group of professional personnel, will be found met by subunits if they are met by the parent agency. The parent agency’s group of professional personnel may serve as the subunit’s group of professional personnel if that group is effectively pursuing its responsibilities for the HHA and its subunits. The parent agency’s and subunit’s records, i.e., policy statements and minutes of group meetings, must establish that attention is being paid to the subunit’s operation in delivering services. The subunit may establish its own group, or the parent HHA may have a subcommittee of its group deal specifically with the subunit’s policies and procedures. The subunit must submit an initial enrollment application Form CMS-855A and undergo an onsite initial survey from the State Agency (SA) or a National Accreditation Organization (AO) with deeming authority, before it is approved to participate in Medicare. The SA completes the Form CMS-2567, or the AO completes the equivalent, and all other applicable documents for the parent organization and each subunit. The SA or AO does not conduct the initial survey of a subunit prior to the initial survey of the parent agency. The CMS certification numbers (CCNs) are assigned numerically by the Regional Office (RO). NOTE: Some states do not allow HHAs to operate subunits. If an HHA resides in a state with this prohibition, the HHA must comply with the more stringent State requirement.