Operation of HHAs Cross State Lines

2184 - Operation of HHAs Cross State Lines (Rev 125, Issued: 10-31-14, Effective: 10-31-14, Implementation: 10-31-14) When an HHA provides services across State lines, whether through its own personnel, or a branch, or subunit, each respective SA must be aware of and approve the action. Each SA must verify that applicable State licensure, personnel licensure, and other requirements are met in its respective State. Any branch or subunit of the HHA must meet applicable State and local laws in the State that it is serving. The provision of services across State lines is appropriate in most circumstances. Areas in which community services, such as hospitals, public transportation, and personnel services are shared on both sides of State boundaries are most likely to generate an extension of HHA services. When an HHA provides services across State lines, it must be certified by the State in which its CCN is based, and its personnel must be qualified in all States in which they provide services. The appropriate SA completes the certification activities. The involved States must have a written reciprocal agreement permitting the HHA to provide services in this manner. The reciprocal agreement must indicate that both States are aware of their respective responsibilities for assessing the HHA’s compliance with the CoPs within their State. The agreement should assure that home visits are conducted to a sample of all patients, in all States served by the HHA. The CMS RO will review the required reciprocal agreement between the States to assure that the SA in which the branch resides is assuming responsibility for any necessary surveys of the branch. If the SAs involved are unable to come to an acceptable arrangement on assuring the necessary surveys of the branch, even though there may be an existing reciprocal agreement between the States, or if the reciprocal agreement cannot assure the necessary surveys, the branch should not be approved. The provision of interstate service without a written reciprocal agreement could severely undermine a State’s ability to fulfill its statutory responsibilities under §1864 of the Act to enforce Medicare’s health and safety requirements. It is at the discretion of the States to decide whether entering into reciprocal agreements is in the best interest of their residents, provider markets, and quality assurance and oversight systems. Exhibit 289 contains a model reciprocal agreement document that States may use to assist them in fulfilling their statutory responsibilities under §1864 of the Act to enforce Medicare’s health and safety requirements when an HHA provides services across State lines. In those States that have a reciprocal agreement, providers are not required to be separately approved in each State; consequently they would not have to obtain a separate Medicare provider agreement/number in each State. Providers residing in a State that does not have a written reciprocal survey agreement with a contiguous State are precluded from providing services across State lines. If a State does not have a written reciprocal agreement with other States, the HHA must establish a separate parent agency or subunit in the State in which it wishes to provide services. In the event that an HHA operates in two CMS ROs, the RO responsible for the State in which the HHA provider agreement and CCN is based should take the lead in assuring that the required survey and certification activities are met. A CMS approved branch office may be physically located in a neighboring State if the SAs responsible for certification in each State approve the operation. Subunits of an HHA may be physically located in more than one State. A separate certification is made by the SA where each subunit is located. While the HHA may notify the SA of its proposal to provide services on an interstate basis, and the SA may make a recommendation to the CMS RO in a particular case, it is the CMS RO that has the Medicare approval authority of the parent HHA and assumes final responsibility for approval of the operation across State lines.