Shutdown Impacts on Home Health Services

The current lapse in federal funding has brought a halt to several Medicare operations impacting the home health industry. These include the hospital-at-home waiver program and certain telehealth flexibilities, creating uncertainty for both providers and beneficiaries. However, CMS has emphasized a commitment to maintaining essential functions, particularly those related to immediate patient safety.

According to a revised memo issued Tuesday, complaint investigations focused on allegations of harm are considered “excepted activities” – those legally permissible during a funding lapse. This means that investigations initiated due to reported instances of potential patient harm will proceed, and appropriate enforcement actions may still be implemented.

The memo explicitly states that during a shutdown, federal survey and certification activities are limited to those deemed essential for the safety of human life or the protection of property. States are permitted to carry out functions under state law, but these cannot be presented as federal activities.

Surveys recently completed that did not reveal immediate jeopardy or harm to patients will be postponed until federal funding is restored. However, any situation posing an immediate threat to a Medicare beneficiary’s well-being will continue to be addressed promptly. CMS acknowledged the disruption, stating, “We deeply regret the necessity to curtail federal survey and certification functions,” while reinforcing that state licensure and enforcement actions are unaffected.

Revisit surveys, specifically those needed to verify the correction of immediate jeopardy or patient harm, are also authorized to continue. Standard Medicare recertification surveys, including those mandated for home health agencies, are suspended, with the exception of hospice surveys funded by the Consolidated Appropriations Act (CAA) of 2021.

Data collection activities, such as those involving the Minimum Data Set (MDS) or the Outcome and Assessment Information Set (OASIS), are also paused, except for what is necessary to maintain essential provider reporting. Initial surveys and certifications are similarly suspended.

Experts have consistently highlighted that complaint surveys represent the most challenging aspect of the survey process for home health agencies, requiring meticulous preparation. This underscores the importance of robust compliance protocols.

What strategies are home health agencies employing to maintain compliance during this period of uncertainty? And how might these temporary disruptions impact the long-term delivery of home-based care?

For further information on navigating healthcare regulations, consider resources from the American Hospital Association and the National Association of Health Underwriters.

Frequently Asked Questions About Medicare Surveys During the Shutdown

• What types of Medicare surveys are paused during the government shutdown?

  Standard Medicare-funded recertification surveys, statutorily mandated surveys impacting home health agencies (excluding hospice), initial surveys, and initial certifications are all paused.

• Are all Medicare complaint investigations suspended during the shutdown?

  No, complaint investigations alleging patient harm are considered essential and will continue. Certain enforcement actions resulting from these investigations may also proceed.

• What are “excepted activities” as defined by CMS during a shutdown?

  “Excepted activities” are those directly related to the safety of human life or the protection of property. Only these activities are legally permissible during a lapse in federal funding.

• How does the shutdown affect MDS and OASIS data collection?

  MDS and OASIS activities are paused, except for what is necessary to maintain essential provider reporting requirements.

• Will revisit surveys always continue during the shutdown?

  Revisit surveys will continue if they are necessary to ensure that immediate jeopardy or patient harm has been adequately addressed.