STANDARD AND EXTENDED SURVEY.

SEC. 4022. STANDARD AND EXTENDED SURVEY. (a) In General.— Section 1891 of the Social Security Act (as added by section 4021) is amended by adding at the end the following new subsections: 101 STAT. 1330–70 “(c) (1) Any agreement entered into or renewed by the Secretary pursuant to section 1864 relating to home health agencies shall provide that the appropriate State or local agency shall conduct, without any prior notice, a standard survey of each home health agency. Any individual who notifies (or causes to be notified) a home health agency of the time or date on which such a survey is scheduled to be conducted is subject to a civil money penalty of not to exceed $2,000. The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penalties under section 1128A. The Secretary shall review each State’s or local agency’s procedures for scheduling and conduct of standard surveys to assure that the State or agency has taken all reasonable steps to avoid giving notice of such a survey through the scheduling procedures and the conduct of the surveys themselves. “(2) (A) Except as provided in subparagraph (B), each home health agency shall be subject to a standard survey not later than 15 months after the date of the previous standard survey conducted under this paragraph. The statewide 27a27aCopy read “Statewide”. average interval between standard surveys of any home health agency shall not exceed 12 months. “(B) If not otherwise conducted under subparagraph (A), a standard survey (or an abbreviated standard survey) of an agency— “(i) may be conducted within 2 months of any change of a ownership, administration, or management of the agency to determine whether the change has resulted in any decline in the quality of care furnished by the agency, and “(ii) shall be conducted within 2 months of when a significant number of complaints have been reported with respect to the agency to the Secretary, the State, the entity responsible for the licensing of the agency, the State or local agency responsible for maintaining a toll-free hotline and investigative unit (under section 1864(a)), or any other appropriate Federal, State, or local agency. “(C) A standard survey conducted under this paragraph with respect to a home health agency— “(i) shall include (to the extent practicable), for a case-mix stratified sample of individuals furnished items or services by the agency— “(I) visits to the homes of such individuals, but only with the consent of such individuals, for the purpose of evaluating (in accordance with a standardized reproducible assessment instrument (or instruments) approved by the Secretary under subsection (d)) the extent to which the quality and scope of items and services furnished by the agency attained and maintained the highest practicable functional capacity of each such individual as reflected in such individual’s written plan of care required under section 1861(m) and clinical records required under section 1861(o)(3); and “(II) a survey of the quality of care and services furnished by the agency as measured by indicators of medical, nursing, and rehabilitative care; “(ii) shall be based upon a protocol that is developed, tested, and validated by the Secretary not later than January 1, 1989; and “(iii) shall be conducted by an individual— 101 STAT. 1330–71 “(I) who meets minimum qualifications established by the Secretary not later than July 1, 1989, “(II) who is not serving (or has not served within the previous 2 years) as a member of the staff of, or as a consultant to, the home health agency surveyed respecting compliance with the conditions of participation specified in or pursuant to section 1861(o) or subsection (a) of this section, and “(III) who has no personal or familial financial interest in the home health agency surveyed. “(D) Each home health agency that is found, under a standard survey, to have provided substandard care shall be subject to an extended survey to review and identify the policies and procedures which produced such substandard care and to determine whether the agency has complied with the conditions of participation specified in or pursuant to section 1861(o) or subsection (a) of this section. Any other agency may, at the Secretary’s or State’s discretion, be subject to such an extended survey (or a partial extended survey). The extended survey shall be conducted immediately after the standard survey (or, if not practical, not later than 2 weeks after the date of completion of the standard survey). “(E) Nothing in this paragraph shall be construed as requiring an extended (or partial extended) survey as a prerequisite to imposing a sanction against an agency under subsection (e) on the basis of the findings of a standard survey. “(d) (1) Not later than January 1, 1989, the Secretary shall designate an assessment instrument (or instruments) for use by an agency in complying with subsection (c)(2)(C)(I). “(2) (A) Not later than January 1, 1991, the Secretary shall— “(i) evaluate the assessment process, “(ii) report to Congress on the results of such evaluation, and “(iii) based on such evaluation, make such modifications in the assessment process as the Secretary determines are appropriate. “(B) The Secretary shall periodically update the evaluation conducted under subparagraph (A), report the results of such update to Congress, and, based on such update, make such modifications in the assessment process as the Secretary determines are appropriate. “(3) The Secretary shall provide for the comprehensive training of State and Federal surveyors in matters relating to the performance of standard and extended surveys under this section, including the use of any assessment instrument (or instruments) designated under paragraph (1).”. (b) Effective Date.— Except as otherwise specifically provided in section 1891(d) of the Social Security Act (as added by subsection (a)), the amendment made by subsection (a) shall become effective on the first day of the 18th calendar month to begin after the date of the enactment of this Act.