AHCA Home Health
Regulatory Update
Anne Menard
Home Care Unit
Bureau of Health Facility Regulation
Agency for Health Care Administration
July 24, 2012
1
Licensed as of July 13, 2012
2,272 home health agencies
Most: Miami-Dade 743
Broward 251 Palm Beach 195
416 nurse registries
Broward 97
Palm Beach 95
2,174 homemaker companion services
Miami-Dade 315 Broward 216
2
2,272 Home Health Agencies
• 71% Certified for Medicare and/or Medicaid
– 1,070 Medicare only
– 68 Medicaid only
– 472 Medicare & Medicaid
• 661 (29%) are not certified, but 154 pending
of the 507 not seeking certification, only
about 90 do not provide any nursing
3
AHCA for HHAs
Secretary
Division of
Health Quality Assurance
Complaint Call Center
1-888-419-3456
Bureau of Health
Facility Regulation
Home Care Unit
Division of Medicaid
Bureau of
Medicaid Services
Bureau of Medicaid
Contract Management
(policy)
(provider enrollment)
Bureau of Field
Operations
Bureau of Central Services
Background
Screening Unit
8 Field Offices
(surveys)
OASIS Help Desk
(850) 412-4501
Financial
Analysis Unit
4
Background Screening Update
From the definitions in Chapter 435, Employment Screening:
435.02(2), F.S. “Employee” means any person required by law to
be screened pursuant to this chapter, including, but not limited to,
persons who are contractors, licensees, or volunteers.
(3) “Employer” means any person or entity required by law to
conduct screening of employees pursuant to this chapter.
5
At the AHCA Background
Screening Web Site Now
Your agency can:
• Track screenings from the time the screening request is
initiated until a determination is made.
• Find results already available (reduces duplicative screening).
• Get a “status” report and a “completed screening listing”
report of screenings requested (eliminates the need to search
for each screening result individually).
• Maintain an employee roster by entering hire and separation
dates for each employee. Get a notification to the employer if
the eligibility status of an employee changes.
6
At the AHCA Background
Screening Web Site now
• See the “Instructions for Initiating and Accessing Screening
Results” at the site.
• Make sure your agency has completed the on-line form for
access to the site through the Web Portal & the Single Sign-On
process.
7
2012 Florida Legislature - Law Changes
Background Screening
HB 943 (Chapter 2012-73, Laws of Florida) effective
April 7, 2012
1. Screening from other state agencies
AHCA may accept proof of Level 2 screening conducted
within the previous 5 years from the Department of Elder
Affairs. DOEA can accept AHCA’s.
Proof of screening received from other state agencies must
use the equivalent screening standards as AHCA.
8
2012 Law Changes - Background Screening
from Other State Agencies
AHCA may accept proof of Level 2 from:
• the Department of Health for CNAs only
• the Department of Children and Families (all but day care,
foster care & adoption)
• the Agency for Persons with Disabilities
• the Department of Elder Affairs.
The individual must not have had a break in service from a
position that requires screening for more than 90 days.
(408.809(2), Florida Statutes).
9
2012 Law Changes - Background Screening
408.809(2)(b), F.S.”…. the agency may accept as
satisfying the requirements of this section proof of
compliance with level 2 screening standards submitted
within the previous 5 years to meet any provider or
professional licensure requirements of the
agency…provided that:…(b) The person subject to
screening has not had a break in service from a position
that requires level 2 screening been unemployed for
more than 90 days;”
10
Background Screening
90 day break in service - how to determine:
• Ask the applicant
• Check with prior employer to verify dates of employment
• See Provider/Facility Types Subject to Screening at the
Background Screening web page – determine if level 2
required
• Once employee rosters are submitted to web, AHCA site will
calculate the 90 day break in service for persons screened
through AHCA.
11
2012 Law Changes
Background Screening
2. Provides a staggered rescreening schedule for
AHCA regulated providers over a 3-year period (2013-2015):
– Individuals for whom the last screening was conducted on
or before December 31, 2004, must be rescreened by July
31, 2013.
– Individuals last screened between January 1, 2005 and
December 31, 2008, must be rescreened by July 31, 2014.
– Individuals last screened between January 1, 2009 and July
31, 2011, must be rescreened by July 31, 2015.
408.809(5), Florida Statutes
12
2012 Law Changes – Background Screening
Staggered Re-Screening - continued
Explanation: Changes in 2010 required all employees to have
level 2 screening (fingerprints, FDLE & FBI) every 5 years
beginning August 1, 2010.
• Many of the persons working at the time of the law change had
level 1 screening & qualified and would be subject to the 5
year rescreening on July 31, 2015.
• The change in law now allows rescreening over a 3-year
period to spread the cost and workload of screening.
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2012 Law Changes
Background Screening
3. Employer may hire a person prior to completion
of a screening for training and orientation purposes.
The individual may not have direct contact with any
patient/client until successful completion of a screening.
(435.06(2)(d), Florida Statutes).
Explanation: Previously, the law prohibited an employer
from hiring an individual until the screening process was
complete and the person was deemed “Eligible”.
If the final screening determination is “Not Eligible”, the
employer must terminate the person or place the person in a
position that is not required to undergo screening.
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2012 Law Changes
Background Screening – Future Implementation
4. Creates the “Care Provider Background Screening
Clearinghouse”
Implementation is expected to begin in October 2012
• Purpose: to provide a single data source for background
screening results of persons required to be screened by law
for employment in a position that provides services to children
& aged and/or disabled individuals. (435.12, F.S.)
• To be entered into the Clearinghouse, the person screened
must:
– Undergo Level 2 screening & have fingerprints retained by
the FDLE and
– Have a photograph taken at time of fingerprinting
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2012 Law Changes - Background Screening Care
Background Screening Clearinghouse continued
•
State agencies that may participate in the Clearinghouse:
– Department of Children and Families
– Department of Health
– Agency for Health Care Administration
– Department of Elder Affairs
– Department of Juvenile Justice
– Agency for Persons with Disabilities
– Vocational Rehabilitation
•
AHCA will be responsible for maintaining the Clearinghouse & will be working
with the other agencies to become part of the Clearinghouse over time.
The fee for retaining fingerprints is $24.00 for 5 years. This fee is in addition to
the screening fee & the Live Scan Service Provider processing fee & is required at
the time of screening.
•
Note: the retention of fingerprints eliminates the need for subsequent
fingerprinting and state rescreening, providing future cost savings.
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Agency for Health Care Administration
Background Screening Resources
AHCA Background Screening Web Site
• http://www.ahca.myflorida.com/backgroundscreening
Contact:
• bgscreen@ahca.myflorida.com
• (850) 412-4503
17
2012 Law Change for Nurse Registries
CS/CS/HB 787 – effective July 1, 2012
400.506(18) “An administrator may manage only one
nurse registry, except that an administrator may manage
up to five registries if all five registries have identical
controlling interests as defined in s. 408.803 and are
located within one agency [AHCA] geographic service
area or within an immediately contiguous county.”
Same as home health agency law
State law has authority over the state ;rule
18
2012 Law Changes - Administrator
continued
“Identical controlling interests” means the nurse
registries share:
• the same legal entity (same Employer ID #)
• have the same people or entities with the exact same % of
ownership – same for management company
• have the same board of directors.
“Immediately contiguous county” means the borders of
the counties touch each other. There needs to be a licensed nurse
registry office in each of the counties that are contiguous.
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2012 Law Changes
Chapter 408, Part II, Florida Statutes
CS/CS/HB 787 – effective July 1, 2012
1. 408.804(3), F.S. “Any person who knowingly alters, defaces,
or falsifies a license certificate issued by the agency, or causes or
procures any person to commit such an offense, commits a
misdemeanor of the second degree, punishable as provided in s.
775.082 or s. 775.083. Any licensee or provider who displays an
altered, defaced, or falsified license certificate is subject to the
penalties set forth in s. 408.815 and an administrative fine of
$1,000 for each day of illegal display.”
20
2012 Law Changes
Chapter 408, Part II, Florida Statutes
2. 408.806(2)(d), F.S. Allows the Agency to send a
courtesy notice, at least 90 days before the expiration of
a license to inform the licensee of the upcoming
expiration date. The courtesy notice will be provided by
e-mail, postcard or letter but not by certified mail.
If the licensee does not receive a notice, the
licensee is still legally obligated to timely file the
renewal application with fee & is not excused from
paying any late fee.
21
2012 Law Changes
Chapter 408, Part II, Florida Statutes
3. A late application fee* will be included in the
omissions letter. It must be paid prior to issuing the
license.
408.804(2)(e), F.S.
Fee is still $50 per day up to a max of $500 for HHA
and NR
* For applications received less than 60 days prior to expiration
but not past the expiration date.
22
2012 Law Changes
Chapter 408, Part II, Florida Statutes
4. 408.810(9), F.S. “A controlling interest shall notify
the agency within 10 days after a court action to initiate
bankruptcy, foreclosure, or eviction proceedings
concerning the provider in which the controlling interest
is a petitioner or defendant.”
23
2012 Law Changes
Chapter 408, Part II, Florida Statutes
5. Fine 408.813(3) - AHCA may impose a fine for a
violation that is not designated as class I, II, III, or IV.
Unless otherwise specified in law, the amount may not
exceed $500 for each violation.
Unclassified violations are:
a. Violating any term or condition of a license
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2012 Law Changes
Chapter 408, Part II, Florida Statutes
Unclassified Violations Fine 408.813(3) continued:
b. Providing services beyond the scope of the license
c. Violating a moratorium imposed per 408.814, F.S
d. Violating any law in this part, authorizing statutes,
or applicable rules.
Example: Not reporting change of administrator
within 21 days (59A-35.110(1)(c), FAC)
25
Homemaker Companion Services
Exemption for APD providers
400.509(1), F.S. “An organization under contract with
the Agency for Persons with Disabilities which provides
companion services only for persons with a
developmental disability, as defined in s. 393.063, is
exempt from registration.”
• If also serving any other client population (such as
elderly persons), not exempt
• Expect about 20% will no longer have to register
26
2012 Law Change for
Nurse Registries & Home Health Agencies
400.462(27), F.S. “‘Remuneration’ means any payment
or other benefit made directly or indirectly, overtly or
covertly, in cash or in kind. However, if the term is used
in any provision of law relating to health care providers,
the term does not apply to an item that has an individual
value of up to $15, including, but not limited to, a
plaque, a certificate, a trophy, or a novelty item that is
intended solely for presentation or is customarily given
away solely for promotional, recognition, or advertising
purposes.”
27
Medicare HHA Update
Change of ownership
• If less than 36 months since initial Medicare enrollment or majority
ownership change, the buyer has to enroll as a new (initial) HHA
with CMS regional HH intermediary & be surveyed.
• Two of the exceptions:
– HHA changing its existing business structure – from corporation,
partnership, or LLC
– HHA parent company is undergoing an internal corporate
restructuring
• See Medicare Program Integrity Manual, Chapter 15
http://www.cms.gov/manuals/downloads/pim83c15.pdf
• CMS letter S & C 12-14-HHA at http://ahca.myflorida.com/homecare at
“Home Health Agency,” see Medicare/Medicaid tab. Check with the
intermediary if questions.
28
Proposed HHA Federal Regulations
CMS-1358-P - July 13, 2012
View at the CMS Home Health Agency Center
www.cms.gov/Medicare/Medicare.html
• New survey & enforcement requirements:
– Civil money penalties (fines) for deficiencies
– An informal dispute resolution (IDR) process (similar to
nursing homes) when conditions of participation are not
met
• 2013 Prospective Payment System rate updates
• Modifications for therapy assessments documentation & face
to face encounter
• Deadline for comments at CMS: Sept 4, 2012
29
FLORIDA MEDICAID STATE PLAN HOME
HEALTH SERVICES
During the 2012 legislative session, the Legislature mandated the
Agency to:
 Reduce the daily limit of home health visits for non-pregnant
adults from 4 per day to 3 per day, effective August 1, 2012;
 Expand the home health agency monitoring pilot project in MiamiDade County on a statewide basis (or in counties determined to be
cost-effective by the Agency); and
 Expand the comprehensive care management pilot project for
home health services statewide (or in counties determined to be
cost-effective by the Agency) and to include private duty nursing
and personal care services.
The current Home Health Coverage and Limitations Handbook,
December 2011, is being updated to include these changes.
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HHA Quarterly Report
400.474(6)(f), F.S.
• Register for the updated quarterly reporting system prior to the
next reporting period 10/1-15/12.
• Users will be able to change passwords online without having
to contact AHCA staff.
• Web pages designed to be more user-friendly.
• Information coming by email to your HHA.
31
Be Current on your Requirements for Personnel
• Some HHAs still require items that are no longer in rules or
laws – or never were.
• Here’s a list I received from a social worker of items HHAs
asked for:
What HHAs required
Required in law or rule?
PPD TB test
No
Chest X ray
No
Physical exam
No
Health statement free from
communicable disease
No for HHA (Yes for Nurse
Registry – 400.506(6)(a), FS)
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What HHAs required
Required in law or rule?
HIV AIDS training biennially
No, only a 1 time course per 381.0035, F.S.
State survey standards only requires HH
Aides, CNAs, homemakers & companions.
Licensed professionals checked by DOH.
Level 2 background screening
Yes
CPR
No – only required of home health aide &
C.N.A. in rule 59A-8.0095(5)(l)
Alzheimer’s Training
Yes – one time only, 2 hours
Domestic Violence training
No
HIPAA training
No
OSHA update
No
33
State HHA Proposed Rule Revisions
Review & comment on proposed changes at
http://ahca.myflorida.com/homecare - select “Home
Health Agency”, also see “Laws, Rules and Survey”
Started review process …
Then will publish in Florida Administrative Weekly,
offer rule hearing, before adoption.
34
HHA Proposed Rule Revisions
Adds 2 items that the law requires AHCA to write rules on:
1. Oversight by the Director of Nursing per 400.497(5), F.S.
The proposed rule additions in 59A-8.0095(2) require the HHA to:
• Have a process to validate that services were provided
• Provide a certified report, if requested by a surveyor, to verify services by a
specific staff person during a specified time period.
• Add to the existing quality assurance program -- a quarterly sample of
clinical records (sample size you determine) to check that:
– (1) only patients whose service needs can be met by the HHA are
accepted; and
– (2) each HHA’s own policies & procedures are followed.
35
HHA Proposed Rule Revisions
2. Use of a recent unannounced licensure survey for a change
of ownership as required in 400.497(6), F.S. Uses surveys
within 24 months to hold down the costs for HHAs. [59A8.003(5)(c)]
Makes other personnel rule changes requested by HHAs:
• Removes the 1-year experience requirement for physical &
occupational therapists & their assistants;
• Clarifies the tasks that a home health aide can do related to
elimination.
36
HHA Proposed Rule Revisions
• Removes the requirement for certified nursing assistants to
have training on specific topics to meet 400.476(3), F.S.
• Adds that homemakers & companions can remind patients to
take their medicine.
Removes rubber stamped signatures for physicians to prevent
fraud.
Removes items that are now in Florida Statutes & 59A-35, FAC
& updates the statutory references in the rules.
37
Home Health Agencies & Physicians
Does the state law or federal regulations require
each HHA to have a medical director? No
Federal regulations for Medicare & Medicaid HHAs require a
group of professional personnel to advise on policies, participate
in evaluation of the HHA’s programs, maintain liaison with other
community agencies, assist with community information…. One
has to be a physician. (42 CFR 484.16)
38
Home Health Agencies & Physicians
400.474(6)(i)(j), F.S.
If you have a physician that you give remuneration to,
this would be your medical director per state law.
• Medical director – only 1 per HHA permitted
Must have written contract, at least 1 year term
Payment must be at fair market value for an hourly
rate
Invoices for medical director payment describe the
work performed, the dates on which that work was
performed, & the duration of that work
39
Physician Orders
Medicare & Medicaid HHAs - The treating or attending
physician that ordered the service is to sign the order. (This is not
necessarily the primary care physician.)
All Medicare & Medicaid services require a physician’s order.
Medicaid allows ARNP, PA if physician also signs the order.
Licensed-only HHAs – Nursing or therapy services requires an
order from a physician, ARNP, or PA.
40
If you don’t agree with the surveyor
1. Ask the surveyor to show you the survey standard or
law, rule
2. Discuss with surveyor at Exit Interview
3. Contact the AHCA Field Office Manager
http://ahca.myflorida.com/MCHQ/areas
4. If still not resolved, contact Chief of Field
Operations, Polly Weaver (850) 412-4301
41
Contacting AHCA
•
When you have questions about your survey or any
standard that was cited as not met
- Call the Field Office Manager or Supervisor
• When you have questions about laws, rules, the
application form or requirements
– 1st check http://ahca.myflorida.com/homecare - select
Home Health Agency or Nurse Registry - See Frequently
Asked Questions or State Regulation Set
– Then call the Home Care Unit (850) 412-4403
or, send an email to
HQAHOMEHEALTH@ahca.myflorida.com
42
Contacting AHCA
• When you have questions about Medicaid letters you
receive, prior authorization, other Medicaid policy:
– Contact the Medicaid area office - see the web site for
phone # & email link http://ahca.myflorida.com/Medicaid
• When you have questions about your Medicaid audit:
– Call the person that sent the letter at the telephone number
in the letter. Ask to speak to that person’s supervisor too, if
needed.
43
If your email has changed since
your last application
• Please let AHCA Home Care Unit know – send an
email to HQAHOMEHEALTH@ahca.myflorida.com
with your correct email address.
• Notices (such as the email on the 2012 law changes &
reminders to renew your license) will get to your
agency quicker if you keep your email current.
44
www.FloridaHealthFinder.gov
To find agencies & facilities
• See Locate , select Facilities and Providers, then Search by
Facility Type/Location
• Now “Advanced Search” has “Service Area”
Select county & get all licensed for that county – includes
those that may not be located in county
• Updated nightly from licensing data
• Can get Excel listings from your search
45
Get the new AHCA Mobile Facility
Locator Application
For information on facilities or agencies & driving
directions…and looking up whether a facility is licensed
See main page of http://ahca.myflorida.com – click on
“Available on the App Store”
46
Contact Information
Anne Menard – Supervisor
Anne.Menard@ahca.myflorida
.com
• Medicare & Medicaid HHA
certification & branch approvals
Cynthia Thomas
Jan Benesh – HHA & NR licensing
manager
• Ed Barnes - Change of ownership,
licensing - HHA/NR
• Lenora Lowry - HHA
• Natarsha Humphries - HHA/NR
• Susan Glass - HHA
• Pat Guilford - NR
(850) 412-4403
HQAHOMEHEALTH@ahca.
myflorida.com
47