Key Steps to Opening a Medicare-Certified Home Health Agency

While starting a new skilled home health agency (HHA) can be exciting and rewarding, it can also be a long and time-intensive process. Although there is a growing need for HHAs with the population of people age 65 and older expected to reach 19.6 percent by 2030, CMS in recent years has imposed significant financial and operational barriers that HHAs must navigate.

Because ACHC was created by home care providers, we understand these unique challenges that you face. Our goal as your partner in accreditation is to offer resources and education to help you through this process and fully prepare you for accreditation. One of these resources that ACHC has recently developed is a free On-Demand Home Health Start-Up Webinar that walks you through the process of starting an HHA in more detail. This webinar can be found on AccreditationUniversity.com.

Below we have outlined some of the key steps to opening a Medicare-Certified HHA.

  1. Determine your states requirements concerning a Certificate of Need (CON)
  2. Determine if state licensure is required in the state where you want to operate
  3. Must meet requirements of CMS State Operations Manual, Chapter 2, Section 2180C
    • Provide Skilled Nursing services and other therapeutic services
    • These services are supervised by a physician or RN
    • Have established policies & procedures
    • Maintain clinical records on all patients
    • Have an overall plan and budget
    • Meet the Medicare Conditions of Participation (CoPs)
    • Meet capitalization requirements
  4. Complete and submit an 855A application to CMS
    • Once approved, submit approval letter to ACHC
  5. Complete a successful test OASIS transmission
  6. Develop patient caseload
    • Must have 10 patients served with 7 active at the time of survey
    • Must meet the definition of CMS skilled care per the Medicare Benefits Policy Manual Chapter 7
  7. Download and review ACHC Accreditation Standards
  8. Submit your ACHC Accreditation application and Preliminary Evidence Report (PER) Checklist
  9. ACHC will complete an on-site survey within 60 days of HHA’s stated readiness

 

IACHC_Certified-Consultant_Sealf you would like more help with getting your agency off the ground, or preparing for accreditation, you may be interested in reaching out to an ACHC Certified Consultant. Our Certified Consultants have been trained in ACHC Accreditation Standards, survey approach, and processes to better prepare healthcare clients for the accreditation survey. Find a Certified Consultant on achc.org.

ACHC Approved for Ongoing Home Health and Hospice Licensure Surveys by State of Maryland

In a recent press release, Accreditation Commission for Health Care (ACHC) announced its approval by the Maryland Department of Health, to perform accreditation surveys in lieu of ongoing state licensure surveys for Home Health agencies and Hospices, in accordance with state law.

“This approval from the Maryland Department of Health means that home health agencies and hospices who are accredited by ACHC will no longer receive ongoing state licensure surveys,” said Teresa Harbour, ACHC’s Program Director for Home Health, Hospice, and Private Duty programs. “We appreciate the value Maryland
Department of Health sees in accreditation and we applaud their willingness to work with us to offer ACHC accredited agencies an alternative to ongoing licensure surveys.”

The Maryland Department of Health has reviewed ACHC’s Accreditation Standards and survey process and confirmed that they meet the state’s licensure requirements. On December 12, 2017, Dr. Patricia Tomsko Nay announced that home health agencies and hospices accredited by ACHC are deemed to comply with Maryland State licensure requirements and are exempt from routine licensure surveys conducted by the Department.

To remain licensed, deemed Home Health agencies and Hospices must continue to submit a renewal application and comply with applicable Maryland Health Care Commission requirements. With the application, the licensee seeking deemed status for state licensure proposes, must submit its currently applicable ACHC inspection results and all supporting documentation.

For more information on ACHC accreditation in-lieu of ongoing licensure surveys in Maryland, contact us at customerservice@achc.org.

The Medicare Home Health CoP Implementation Day is Here!

Today, January 13, 2018, is the day for which all home health agencies have been preparing since CMS finalized the first major revision to the Medicare Home Health Conditions of Participation (CoPs) in more than 20 years. Today, these new CoPs officially go into effect and all home health agencies that bill Medicare must be in full compliance.

ACHC released the revised Home Health Accreditation Standards, which incorporate the new CoPs, on November 15, 2017, and these standards are available to download on Customer Central. As of today, all ACHC customers will be surveyed to these new standards.

As always, agencies must adhere to the most stringent regulations. Requirements deleted from the CoPs may still be valid in your state, so check state licensure requirements, as applicable, prior to revising any current practice.

Make sure to take advantage of the tools and resources ACHC has developed to help educate providers on the expectations for compliance with the new CoPs and ACHC Accreditation Standards:

Accreditation University

Customer Central

We will continue to work diligently to revise all educational materials as we receive more information from CMS, including the Interpretive Guidelines and survey protocols. Watch your email and Customer Central account for these updates.

If you have any questions about the new ACHC Home Health Accreditation Standards or the Medicare CoPs, please contact your personal Account Advisor.

ACHC Accreditation – A New Option for California Home Health Licensure

With more than 500 initial licensure applications pending approval in California, home health agencies are being forced to wait up to two years before receiving their license. To help combat this delay, the California Department of Public Health (CDPH) has given home health agencies the option of working with a CMS-deemed accreditation organization to obtain an initial licensure survey. CDPH is encouraging home health agencies to take advantage of this new option in order to expedite their licensure approval process.

The Accreditation Commission for Health Care (ACHC), a nationally recognized accreditation organization known for providing value, integrity, and the industry’s best customer service, is one of the approved accreditors.

“ACHC is ready to immediately accept applications and assist start-up agencies seamlessly through the licensure process,” said Teresa Harbour, ACHC’s Program Director for Home Health, Hospice, and Private Duty.  “Meeting the needs of California providers is essential to ACHC, so we have created accreditation prep tools and resources specific for these providers.”

Faina Neveleva, Administrator of Signature Home Health Care, was grateful for the training and support her agency received from ACHC. She attended the ACHC Home Health workshop in preparation for her agency’s recent accreditation survey.

“The workshops were so educational. Lisa [ACHC Clinical Compliance Educator] was very patient and answered all of our questions,” added Neveleva. “The free ACHC Accreditation Guide to Success workbook tells you exactly what the Surveyors are looking for. We rely on this so much.”

ACHC is accepting applications for home health licensure and accreditation in California and has already started surveying agencies. Once the application is completed, ACHC guarantees agencies will be surveyed within 25 days.

“We were impressed with how simple and straightforward the ACHC application process was and how quickly we were surveyed,” said Neveleva. “Throughout the whole process, our Account Advisor was very knowledgeable and helpful, returning calls usually within an hour and making sure all our questions were answered.”

Partnering with ACHC not only provides a faster route to licensure, it also allows agencies to reap the benefits of accreditation – ensuring compliance with the Medicare Conditions of Participation (CoPs) and the highest quality standards.

VNA Hospice & Palliative Care of Southern California has been accredited for over 20 years and recently switched to ACHC. Paula Natale, Director of Regulatory Affairs, said the organization switched because the ACHC Accreditation Standards are easy to understand and are more applicable to the home health and hospice services provided by the agency.

“It is a way for us to show our patients, payors, and referral sources that we have achieved a higher standard above and beyond the Medicare CoPs and that we are committed to continuously improving the care we provide,” Natalesaid, reflecting on the value of accreditation.

With more than 1,200 accredited home health agencies across the country, ACHC prides itself on the fact that 98 percent of customers say they would recommend ACHC – and Natale agrees.

“I have recommended ACHC to several colleagues,” she said. “Having experience with other accrediting organizations, I can say that the knowledge, professionalism, and customer service from ACHC Account Advisors, Surveyors, and Clinical team is unmatched in the industry.”

This article was published on Home Health Care News on December 20, 2017.

The Changing Healthcare Environment: An Interview with Kim Bradley, Nurse Executive of Sentara Enterprises

On Behalf of ACHC, the Remington Report interviewed Kim Bradley, Sentara Enterprises, to get insights into the changing healthcare environment and how her organization is handling the challenges. For more than a decade, Sentara has been ranked as one of the nation’s top integrated healthcare systems.  Their not-for-profit system includes advanced imaging centers, nursing and assisted-living centers, outpatient campuses, physical therapy and rehabilitation services, home health and hospice agency, a 3,800-provider medical staff and four medical groups.

 

Remington Report: The move toward value-based care and a rapidly changing healthcare delivery system are just a few of the challenges weighing heavily on the minds of today’s healthcare executives. Explain your organization’s five top challenges.

Bradley: You have accurately identified one of the greatest challenges that we face at Sentara, as in many organizations – and that is, transitioning to a value based mindset while continuing to live, largely, in a fee for service reimbursement environment.  We view this as both a challenge and an opportunity because as patients move through the continuum at a faster pace, we have the opportunity to touch more patients.  Patients come to us earlier and with higher acuities than we’ve seen in the past.

This leads to additional challenges – recruiting, retaining, and training top talent to care for our growing patient population.  Another challenge that we balance is timely and effective communication among multiple business lines in an integrated delivery network.

Remington Report: If you take one of your challenges, what solution (s) would make it possible to make a difference?

Bradley: I believe that tight processes, efficient workflows, evidenced based care protocols, reliable technology that support the clinicians in the field that avoids duplicative documentation are critical. That is a tremendous amount of work that we have committed to performing which allows us to provide excellent care to our high acuity patient population.

Remington Report: In the midst of change, explain the ways your organization is pushing innovation.

Bradley: We are seeking efficient ways to utilize our EMRs.  We are also seeking enhanced and innovative ways to utilize telehealth and virtual visits.

Remington Report: Explain how ACHC’s partnership is providing solutions to your organization.

Bradley: ACHC has proven to be a wonderful partner to Sentara Enterprises throughout our accreditation journey as well as through opening new providers for home health.  They have offered to assist us with review of new policies and procedures for the upcoming CoPs as well as the new Emergency Preparedness guidelines that impact all of our business lines.

ACHC has partnered with us to identify and share best practices.  By doing so, it not only elevates our organization but our industry as a whole.

National Home Care & Hospice Month – Stories from Hospice in the Pines’ We Honor Veterans Program

November is National Home Care & Hospice Month, and the National Hospice and Palliative Care Organization’s (NHPCO) theme for this year is “It’s about how you live!”

ACHC asked agencies to submit stories honoring the lives of the patients they serve. We are excited to share two stories we received from Hospice in the Pines in Lufkin Texas. These two stories are about men this organization serves through their We Honor Veterans program. This program was founded by the National Hospice and Palliative Care Organization in collaboration with the Department of Veteran Affairs that partners with hospice organizations around the nation. We are proud of Hospice of the Pines’ commitment to our veterans and the way they honor the lives of these heroes!

 

Bill Fortune

At 91 years old, Colonel Bill Fortune is an exceptional American hero who served in the United States Air Force during World War II.

This impressive and decorated serviceman is one of two siblings in his family to serve in the United States Military. Collectively his immediate family members and himself have served a total of over 120 years in the military.  Colonel Bill Fortune was one of the first air pilots to fly into an active hurricane.

Today he displays several pictures within his bedroom, above his bed, of the B-29 airplanes which he flew in the war. These images bring such great joy to his mind and heart when reminisced upon. Colonel Fortune was a co-pilot, and served for a total number of 36 years in the United States Military.  Colonel Bill Fortune is a native of Lufkin and has been active until his diagnosis with cancer, yet his lovely and beautiful spirit truly remains ever cheerful to all.

Hospice in the Pines had the honor of recognizing his dedicated service through the We Honor Veterans pinning ceremony. On Friday September 15, 2017, three team members from Hospice in the Pines joined the Fortune family in their home to celebrate the life and servitude of Colonel Fortune. It was a ceremony that doubled as a small family reunion and will forever be a memory in the legacy of Colonel Fortune’s beautiful life. What an honor it was to play a part in showing appreciation to such a dedicated veteran.

 

Tommy Solomon

Tommy Solomon is a United States Veteran who served during the Vietnam War.

Mr. Solomon was stationed in Lackland Airforce Base, he was selected to be a mechanic for his expertise and knowledge of repairing and assembling airplanes. In Mr. Solomon’s home, you will find numerous models of planes decorated with the traditional colors of the F104-Fighter planes and the Douglas DC3 planes, all which Mr. Solomon had assembled, dissembled, fixed, cleaned. Mr. Solomon worked on planes such as the C124, C118, P38 Fighter, and the C121 which he stated, “this was the most beautiful plane ever built”. Mr. Solomon said he will never forget his fellow comrades and the unification they all shared to take care of one another; to always provide servitude, dignity, shared values and most importantly faith and unity with one another.

Mr. Solomon’s spirit, strength and humor can still be felt and seen every day. His art and Greek mythological statues and images that can be found in his home, remind him of living in Greece for a short duration of his life.  Mr. Solomon loves to spend his time with his family and his many pets.

Hospice in the Pines was honored to acknowledge his service to our country through the We Honor Veterans pinning ceremony. Mr. Solomon’s dedicated service is a glimpse at the wonderful and beautiful life he has lived. We are forever grateful for his service.

National Home Care & Hospice Month – Share Your Story with ACHC!

November is National Home Care & Hospice Month, and the National Hospice and Palliative Care Organization’s (NHPCO) theme for this year is “It’s about how you live!”

ACHC wants to hear how your agency lives out this motto! Help us raise awareness about home care and hospice services by sharing an example of how you help your patients achieve a better quality of life. Email us your story at ainfo@achc.org, comment on our Facebook page, or tag us on Twitter.

At the end of the month we will select one participating agency to win a $50 Starbucks gift card! We will also be featuring your stories on the ACHC Blog, social media, and in the ACHC Today e-newsletter.

If you are looking for ways to celebrate and raise awareness about home care and hospice services this month, check out the National Association for Home Care and Hospice (NAHC) list of Celebration Ideas.

In this season of thanksgiving, we want you to know how grateful we are for the high-quality care you bring to your patients. We are truly blessed to be your accreditation partner!

Now Available: ACHC Home Health Standards & Educational Resources – Revised Medicare CoPs

On January, 9, 2017, CMS finalized the first major revision to the Medicare Home Health Conditions of Participation (CoPs) in more than 20 years. The implementation date for these new CoPs is January 13, 2018 and the phase-in date for Performance Improvement Projects is July 13, 2018, with all other QAPI requirements effective January 13, 2018.

The revised ACHC Home Health Accreditation Standards, which incorporate the new CoPs, are now available to download on Customer Central. In accordance with the implementation date, ACHC will begin surveying against these new standards on January 13, 2018.

As always, agencies must adhere to the most stringent regulations. Requirements deleted from the CoPs may still be valid in your state, so check state licensure requirements, as applicable, prior to revising any current practice.

We know that with these revisions comes heightened anxiety and concern regarding the ability to demonstrate compliance. ACHC has developed tools and resources to help educate providers on the expectations for compliance with the new CoPs and ACHC Accreditation Standards:

Accreditation University

Customer Central

 

 

Are You in Compliance with Emergency Preparedness Requirements?

On September 8, 2016, the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. Healthcare providers and suppliers affected by this rule must comply with and implement all regulations by November 15, 2017.

These Emergency Preparedness regulations have been incorporated into the Home Health Conditions of Participation (CoPs) and the Hospice requirements are in the State Operations Manual, Appendix Z- Emergency Preparedness for All Providers and Certified Supplier Types, Interpretive Guidance. ACHC recently received approval from the Centers for Medicare & Medicaid Services (CMS) for the revised ACHC Accreditation Standards that incorporate the new Emergency Preparedness requirements. These new standards are available to download on Customer Central.

You can view the interpretive guidelines and valuable resources to assist with developing your agency’s Emergency Preparedness Plan online.

ACHC has developed several educational resources to help you prepare for compliance with Emergency Preparedness Conditions of Participation:

Customer Central

DYK Educational Emails

Accreditation University

1st Recipient of ACHC’s Distinction in Hazardous Drug Handling Cites Positive Experience

PCAB-accredited Pharmacy Specialties & Clinic of Sioux Falls, SD, achieved an additional recognition in September when it became the first to receive ACHC’s new Distinction in Hazardous Drug Handling (HDH).

The Distinction in HDH gives ACHC- and PCAB-accredited pharmacies a means to demonstrate compliance with criteria set forth in USP Chapter <800> Hazardous Drugs – Handling in Healthcare Settings. While not set to go into effect until 2019, many pharmacies are taking proactive steps to ensure preparedness with these guidelines aimed at protecting pharmacist and patient safety.

Below, PS&C President Cheri Kraemer talks about her pharmacy’s experience preparing for and undergoing the HDH survey, and offers advice for those who may be considering it.

ACHC: Why did you decide to make your facility USP <800> compliant?

Kraemer: I have always tried to protect my employees from chemicals they work with on a daily basis and I have had a powder room for making capsules and hormones since 2010 so I just decided to finish the entire process since the deadline was July 1, 2018*, and I wanted to be ready.  I would rather be first to act than last when dealing with employee safety. (*The implementation date has since been postponed until December 1, 2019.)

ACHC: What were some of your biggest challenges?

Kraemer: I decided to move the cleanroom, which required a remodel.  We had glass walls and ledges in our old cleanroom, so to make it more efficient for cleaning, we built out a new cleanroom with a hard top, epoxy painted walls, and concave floors.

ACHC: What surprises did you encounter?

Kraemer: The expense; it is always hard to know what things will cost.  So to prepare, I sold my retail pharmacy portion to a local retail chain in order to have money to remodel and do this all properly.  We are compounding only now.  We do less than 5% sterile but I feel ready to do more now that we have gone through all the inspections.  I know many compounding pharmacies are dropping sterile because of the expense to make the changes needed. I want patients in South Dakota and our surrounding states to have access to all areas of compounding.

ACHC: What was easier than you thought?

Kraemer: The hazardous area was quite easy for me because I had a room separated already for many years.  I just needed to vent the hoods outside and designate the area hazardous; separate chemicals; change gowning procedures; and rethink all the various workflow processes.  An example is that you need more equipment. We needed a second ointment mill to put in the hazardous room for topiramate pediatric suspensions made from commercial tablets.

ACHC: What pearls of wisdom might you share with a pharmacy in the beginning stages of preparation for USP <800>?

Kraemer: Consider the hoods you will purchase before the buildout.  We did not make the ceiling in our sterile hazardous room high enough.  It should have been 1 foot taller to accommodate the new BioView hood.  I could not have known that because I did not realize the hood I was getting to put in there was so tall. The hood should be raised up for comfort.

ACHC: How do you feel about ACHC’s approach to addressing USP <800>?

Kraemer: I thought it was very thorough.   Going in to USP <800> certification, the Distinction in Hazardous Drug Handling, I had questions about the extra waste we will create using so many more chemo items.  It was really nice to have Jon Pritchett with ACHC and Brenda Jensen with Compound Consultants to work with regarding some of these details.

ACHC: Do you feel that the Distinction in HDH standards adequately addressed the chapter?

Kraemer: Yes, I was very ready for the inspection after working through the requirements set forth by ACHC/PCAB.

ACHC: Where do you see the compounding industry going? Do you think that hazardous drug handling will continue to be a topic of conversation?

Kraemer: I am ready for HD handling across the board, sterile and non-sterile.  I feel that if I could do this, everyone can do this and should do it sooner rather than later.  It is about safety to your employees, which should be the most important thing to consider when compounding with bulk chemicals and handling other NIOSH list medications.  I feel the sooner this all gets in place, the better for everyone in our industry.