Medicare Rules Clarification and Enforcement
The Medicare Advocacy concept must include the concept of Accountability as well.
The lack of oversight of home health agencies (HHA's) has led to the diminishment of the Medicare long term care services benefit. The Center for Medicare Advocacy, Inc. offers a CD training program on "Medicare Home Health Coverage as a Long Term Care Benefit". It outlines the requirements for beneficiaires to receive up to 28 hrs. (in special circumstances 35 hrs.) per week of combined home health services. Most of those hours involve the services of home health aides, the direct care wokers, who provide personal cares, therapy support, light housekeeping and meal preparation to qualified clients.
In July of 2002, the GAO (Government Accounting Office) issued a report to Congress on oversight of Medicare-certified home health agencies. The approximately 6,900 home health agencies that serve Medicare beneficiaries must follow the rules for home health coverage, known as Conditions of Participation (CoP's), intended to ensure that home health agencies have the appropriate staff, are following the plan of care specified by a physician, etc. To verify compliance with these and other requirements, the federal government contracts with states to periodically conduct an inspection, known as a standard survey, at each agency. Failure to meet a Medicare CoP may result in termination from the program. Unfortunately, the federal government did not implement any statutorily authorized sanctions, such as civil monetary penalties for home health agencies that fail to comply with the Conditions of Participation. The GAO report concluded: "Oversight of HHA's has become even more important since the implementation of a new prospective payment system (PPS) in October 2000 that encourages home health agencies to provide care more efficiently but also provides an incentive to reduce services in order to increase net revenues "
