Surveying Health Maintenance Organization (HMO)-Operated

2194 - Surveying Health Maintenance Organization (HMO)-Operated Home Health Agencies (HHAs) Providing Home Health Services Through Medicare Survey and Certification Process (Rev. 1, 05-21-04) The HMOs (Medicare+Choice) which contract with Medicare to furnish HHA services may provide such services either directly by the HMO or through Medicare-approved HHAs that have a provider agreement/number with Medicare. (See 42 CFR Part 417.416(a) and 42 CFR Part 422.20(b)(3).) If an HMO provides home health services directly as an integral part of the HMO, the HHA is still required to meet the HHA CoPs, including the OASIS requirements, have a Medicare provider number, enter into a provider agreement with the Secretary, and meet other survey and certification requirements, including Office of Civil Rights and enrollment requirements, that an HHA approved under 42 CFR Part 484.1 would have to comply with. When the SA receives a request to survey an HMO-operated HHA for compliance with the HHA CoPs, it schedules an unannounced standard survey. The SA conducts the survey, and documents its findings on Form CMS-1572. The SA completes Form CMS- 2567, obtains a PoC when necessary, and sends this information along with a completed Form CMS-1539 to the CMS RO. The SA resurveys approved HMO-operated HHAs according to the survey frequency allowed by the Secretary and determined by the SA to assure quality care and to ascertain whether they continue to meet the HHA CoPs. In essence, these HHAs are surveyed and certified the same as any other Medicare-approved HHAs.