Home Health Intermediate Sanctions: Everything Changed on July 1

Why Should You Attend:

In 2011, CMS announced it was exercising its authority to implement alternative sanctions for the home health survey process. On July 1, 2014, the final element of those sanctions goes into effect. For the first time, home health providers will be exposed to the potential of civil monetary penalties and payment suspensions for condition level survey violations. Although these sanctions are supposed to be a way to get providers to achieve compliance without termination, the reality of payment suspensions and daily fines may be much worse.

Another important consideration is what remedies a provider can implement when sanctions are imposed. The regulations provide two options: information dispute resolution and appeals.

This webinar on CMS intermediate sanctions will:

• Introduce each of the available sanctions and which ones historically have been used most frequently by CMS.
• Review both the Immediate Jeopardy requirements and the more traditional condition level sanctions.
• Discuss the considerations for CMS imposing sanctions.
• Review the regulatory requirements for increasing or decreasing sanctions on a resurvey that finds continued non-compliance.
• Explain information dispute resolution (IDR), how to obtain an IDR and what relief it may provide.
• Discuss strategy consideration of using the IDR and how an IDR differs from an appeal.
• Review the requirements related to a formal appeal and how appealing impacts the process.
• Explore the option to waive your right to an appeal in exchange for a discount of the penalty amount.
• Focus on the most common survey mistakes agencies face. It will consider survey preparation and responding to surveyors. Finally, it will discuss incorporating survey and certification issues into your compliance program as a means to avoid citations.

Areas Covered in the Webinar:

• CMS authority to impose alternative sanctions
• Types of sanctions available to providers
• How sanctions are imposed, how sanctions are lifted
• What is a repeat finding and how does it impact sanction decisions.
• Clarification on sanctions from CMS
• What does the nursing home industry's experience tell us?
• What is an IDR
• How the IDR process will impact providers
• Providers right to appeal
• How survey compliance is more important than ever
• How to incorporate survey compliance into your compliance program.

Who Will Benefit:

• Administrators
• Director of Nursing
• Owners
• Executives

Instructor Profile:

For more than ten years, Robert W. Markette, Jr., CHC, has focused his practice on representing home health, hospice and private duty providers in all aspects of their operations. With more than a decade of experience in working with the home health, hospice and private duty industries, Robert has developed a reputation for understanding the issues facing homecare providers.

In representing the homecare industry, Robert has gained assisted clients in a number of areas related to the operation of their business. He work with his client on issues related to Medicare/Medicaid compliance including surveys, responding to surveys, state and federal appeals of survey findings; payer issues, including appealing payer audit findings; HIPAA Compliance; Medicare and Medicaid fraud and abuse, including matters such as developing and implementing compliance programs, performing internal investigations and representing providers in external investigations and civil and criminal matters. Robert also assists clients with purchasing and selling home health, hospice and private duty agencies.

Because these providers depend heavily on their staff, Robert also addresses legal issues related to employment matters. This includes wage and hour compliance, responding to Department of Labor investigations, and litigating wage and hour disputes. Robert routinely provides guidance to his clients on HR matters, including assisting with preparing personnel manuals, guidance on discipline issues and similar matters. Robert also assists clients in responding to EEOC investigations and discrimination lawsuits and similar employment issues.

Robert is certified in health care compliance by the Health Care Compliance Board. Robert is admitted to practice in Indiana and Oklahoma. Robert is recognized for his expertise in this space and is a frequent speaker on home health, hospice and private duty matters across the country. Robert has presented to the American Health Lawyers Association, the National Association for Home Health and Hospice Care, as well as other national speaking events and numerous state trade association conferences and continuing education sessions.

Robert graduated from Hanover College with a degree in Computer Science and received his law degree from Indiana University School of Law in Bloomington, Indiana. During law school he served on the Federal Communications Law Journal. Robert is a member of the American Health Lawyers Association, the Health Care Compliance Association and the Indiana and Oklahoma State Bar Association.

Topic Background:

Although alternative sanctions were touted as a way to obtain compliance without placing agencies on the termination track, the reality may be significantly different. Under its alternative sanction authority, CMS can impose per day fines for non-compliance as well as payment suspensions for identified condition level deficiencies. A payment suspension or daily fine that continues until the agency achieves compliance may be devastating to a provider. In fact, a significant sanction may result in an effective termination, due to a provider's inability to pay.

Given the potential ramifications of alternative sanctions, it is important for providers to be aware of how the alternative sanctions will operate.

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