Home Care Profiles provides useful information about each home care provider in New York State. This page includes explanations of programs, quality measures, and inspection results.
Program Description
Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs (LTHHCPs)
CHHAs/LTHHCPs provide part time, intermittent, skilled services which are of a preventative, therapeutic, rehabilitative, health guidance and/or supportive nature to persons at home. Home health services include: nursing services; home health aide services; medical supplies, equipment and appliances suitable for use in the home; and at least one additional service that may include physical therapy; occupational therapy; speech pathology; nutritional services; and medical social services. Services provided by CHHAs/LTHHCPs may be reimbursed by Medicare, Medicaid, private payment, and commercial health insurers. The NYS Department of Health is responsible for monitoring the care provided by CHHAs/LTHHCPs.
Quality measurement data are available for these provider types. In addition, the Department of Health conducts periodic surveys and investigates complaints at these agencies. If there are findings that a violation of rules and regulations exist during such activities, a written report called a Statement of Deficiencies is issued and the agency must submit a plan of correction to the Department within 10 days. This plan must specifically indicate how the agency will return to and maintain compliance with each rule or regulation it violated. The most recent inspection data is published on this site.
Special Needs CHHAs
A Special Needs CHHA is a Certified Home Health Agency that has been approved by the Department of Health to serve an identified specific targeted population or identified special needs population. The Special Needs CHHA provides the same services that a general purpose CHHA provides. The targeted populations fall into two categories:
- Populations eligible for services from the Office of Mental Health (OMH) or Office for People with Developmental Disabilities (OPWDD): The Special Needs Certified Home Health Agency provides services to a population of patients in their homes who would otherwise require care in a facility or program licensed by either OMH or OPWDD.
- Pilot Program Home Health Agencies: Ten such agencies are permitted under regulations to provide services to a particular population group and that population group's identified special needs. During the application process, these agencies demonstrated that they were better able than other certified home health agencies to meet the special needs of the defined population group in the areas of improved continuity of care, access to services, cost effectiveness and efficiency.
Home Care Quality
Home care is a health service provided in the patient's home to promote, maintain, or restore health or lessen the effects of illness and disability. Services may include nursing care, speech, physical and occupational therapies, home health aide services and personal care services. Home care quality measures give an indication of how well a certified home health agency/long term home health care program (CHHA/LTHHCP) provides care for its patients. Home Care Profiles display a set of quality measures that highlight ways in which CHHA/LTHHCP differ from one another.
About the Quality Measure Data
Data for quality measures come from Medicare claims, the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, and the national Outcome and Assessment Information Set (OASIS) repository. The HHCAHPS survey is a patient experience of care survey that collects feedback from patients and families about their experience with a certified home health agency. The OASIS is a federally-mandated assessment conducted by CHHA/LTHHCP professional staff at regular intervals for patients receiving Medicaid or Medicare skilled home health services. Information is collected about the patient’s health, physical functioning, mental status, and general well-being. These data are used by the CHHA/LTHHCP for outcome monitoring, clinical assessment and other internal agency-level applications.
Quality measures show how often each agency used best practices when caring for its patients and whether patients improved in certain important areas of care. For some quality measures, a higher rate is better, while for others, a lower rate is better. Quality measures are calculated using 12 months of data, and are typically updated each calendar quarter, reflecting the most recently-available quarter. The Centers for Medicare and Medicaid Services (CMS) oversees all quality measures. The quality measures are available for download from the Home Health Compare website. For more information, please visit the Home Health Quality Measures page. New York State Department of Health has developed the methodology for quality measure domain rating and overall star rating. These ratings allow us to compare the CHHA/LTHHCP within New York State.
Quality Measure Domain Ratings
The home health quality measures are categorized into five domains of care. Domains represent the quality of care for a group of people or condition and may include several measures of care relevant to the group or condition. Domains are rated one through five stars. One star indicates the poorest rating, and five stars indicate the best rating. The Overall Rating is a normalized star rating based on the agencies’ performance across the five domains. The normalization of the Overall Rating resets the distribution, with the highest performing CHHA/LTHHCP across all the domains having five stars and the lowest performing CHHA/LTHHCP across the five domains having one star.
The domain ratings are calculated in three steps, described below.
1. Measures
- The measure rates are standardized by creating percentile ranks.
- The percentile ranks are converted to measure scores. For example, a percentile rank of 20 converts to a measure score of 20.
2. Domains
- The measure scores for all the measures in a domain are added together.
- The sum of the measure scores is divided by the number of measures in the domain. For example, if there are four measures in a domain, the sum of the measure scores is divided by four. This is the domain score.
- The domain rating (i.e. the number of stars assigned to the domain) is calculated by normalizing the domain scores using the method below.
- The test statistic of the domain scores is calculated. Test statistic = (agency's average domain score – statewide average of the domain) / standard error
- The normal distribution percentile of the test statistic is determined.
- A domain star rating is assigned based on the percentile test statistic table below.
| Percentile of Test Statistic | Star Rating |
|---|---|
| 0 <= percentile < 10 | 1 STAR |
| 10 <= percentile < 30 | 2 STARS |
| 30 <= percentile < 70 | 3 STARS |
| 70 <= percentile < 90 | 4 STARS |
| 90 <= percentile | 5 STARS |
3. Overall Star Rating
- The star ratings from each domain are added together.
- The sum of the domain star ratings is divided by the total number of domains. This is the overall score.
- The overall star rating is calculated in the same way that the domain ratings are calculated above.
Missing Domain Ratings
If a quality measure denominator has fewer than 30 people in it, the rate is not available. If this happens to half or more of the measures within a domain, the CHHA/LTHHCP does not receive a star rating for that domain.
If the star ratings are missing for all domains, the CHHA/LTHHCP does not have an overall star rating. Individual quality measure rates are still shown so long as the measure denominators are 30 or more.
Inspections
State Inspection Process
The New York State Department of Health conducts inspections on and licenses the Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs, Hospices, Licensed Home Care Services Agencies (LHCSAs) and limited licensed home care services agencies that are approved to operate in New York State. Agencies are monitored by standard periodic inspections that include state licensure surveys, federal certification surveys, and recertification surveys to ensure that they meet federal and/or state regulations, which govern them. Any physical plants are inspected to meet Life Safety Code requirements as well. All reported complaints are also investigated to determine if corrective action is necessary by the agency.
Surveys
The Department conducts an initial state licensure survey prior to the opening of an agency to assure appropriate operations are in place to serve patients. Once licensed and operational, a certified home health agency, long term home health care program or hospice must demonstrate that they meet the federal conditions of participation to be eligible to accept federal Medicare / Medicaid patients at a certification survey. After certification, periodic recertification surveys are performed at intervals set by state or federal guidelines. These surveys are unannounced and usually conducted during weekdays during regular business hours. CHHAs and Long Term Home Health Care Programs are inspected at a maximum interval of 36 months; Hospices at a maximum interval of 36 months, and Licensed or limited licensed home care services agencies at 36 month intervals.
Deficiencies
When regulatory requirements have not been met, the deficiency is identified to the agency in a written report to which the agency must respond with a corrective action plan. Deficiencies are categorized into two levels.
- A standard level deficiency identifies areas of non-compliance with regulations that are of limited consequence and do not significantly impact on outcomes of care for patients and the agency's ability to provide services of adequate quality.
- A serious deficiency, also called a condition level deficiency, identifies the practices of an agency that negatively impacts their ability to provide services of adequate quality to all its patients. These deficiencies may have resulted in poor outcome(s) of care for one or more patients or placed some or all agency patients at significant risk for poor outcomes.
Inspection results are reported by the Department in writing to the agencies within two weeks of the survey. The report identifies each rule that is violated, along with a description of the evidence to support the finding.
In response to each deficiency, the agency must submit within 10 calendar days a written detailed corrective action plan. The plan describes how and by what specific date the finding will be corrected. The plan must also describe what changes will be made to prevent reoccurrence and how the agency will monitor these changes to ensure their effectiveness.
An agency that receives serious deficiencies must correct all findings within 90 days. Failure to do so will result in the agency's termination from participation in the Medicare and Medicaid programs. In that event, patients would be transferred within the next thirty days to another agency, or if necessary for safe care, admitted to an inpatient service. Such termination activity is monitored daily by the Department of Health.
Follow-up/Revisit
The Department reviews the corrective plan and must find the plan acceptable before the provider is found to be back in compliance. The provider must implement the plan of correction, evaluate its effectiveness in achieving full compliance with the regulation. The survey team conducts a follow-up revisit after the completion date indicated on the agency's plan of correction to ensure that the agency has implemented the plan successfully. Serious deficiencies must be corrected as determined by a revisit within 90 days or the agency will be required to terminate operation. The Department may undertake an enforcement action, which will levy a fine against an agency for each serious deficiency cited.
Since actual survey results can be technically or medically complex and sometimes difficult to interpret, the Department has created Inspection Reports to present this information in a manner that is more understandable to the general public. These reports will help consumers compare, evaluate and choose an agency. All information is updated regularly to reflect the last survey interval for both Surveys and Complaint investigations.
Inspection Reports
Standard Health Inspections
Survey teams are comprised of health care professionals trained in nursing and social work. During a standard health inspection, the survey team will review the quality of the care provided by the agency to their patients. The comprehensive assessment of patients with the resulting plans of care; personnel records; and the agency's internal reports regarding operational organization, administration, and quality review are reviewed as part of this process. Additionally, visits are made to observe care being provided in patient homes in the community to observe and evaluate the care provided.
Life Safety Code Inspections
The survey focuses on safety and covers a wide range of aspects of fire protection, including construction, protection and operational features designed to provide safety from fire, smoke, and panic as established by the National Fire Protection Agency (NFPA).
Complaint Investigations
The home care surveillance program involves the investigation of complaints concerning home care services to ensure that all patients are offered adequate and safe quality care. Complaints are prioritized to determine the immediacy of need for investigation. Low priority complaints may await the next standard health inspection, while higher priority complaints are investigated immediately. In some cases an offsite administrative review (e.g. written/verbal communication or documentation) may suffice. When appropriate, complaints may be referred to other bureaus within the department who oversee other provider types involved with services to home care patients.
The NYS Department of Health is responsible for monitoring the care provided by home care agencies. Complaints, questions or concerns about any certified home health agencies should be directed to the Home Health Hotline (800-628-5972). You can also submit a complaint at http://profiles.health.ny.gov/home_care/pages/complaints.
About Home Care Enforcement
Section 12 of the Public Health Law allows the Department of Health to assess fines against home care and hospice providers that have been cited for noncompliance with federal or state regulations that resulted in poor outcomes of care or harm to patients, represents substandard quality of care, or places patients at immediate risk for poor outcomes of care or harm.
The maximum fine allowed under law is $2,000 per violation. The Enforcement Summary Report presents a 10-year history of fines assessed against each home care/hospice provider. The information includes:
- Statement of Deficiencies: The date(s) of the inspection report identifying violations of rules and/or regulations that resulted in the imposition of the fine.
- Deficiency Category: The rules or regulations found in Title 10 of the New York Code of Rules and Regulations (10 NYCRR) that were determined to be violated as documented on the statement(s) of deficiencies.
- Stipulation and Order: The agreement signed by the Department and the home care/hospice provider which identifies the deficiency and the amount of the fine for the violation.
- Stipulation and Order Date: The date the Stipulation and Order was signed.
- Fine: The total amount of the fine assessed against the facility is listed. Portions of the fine may be suspended contingent upon the agency meeting specific requirements listed in the stipulation and order. If a second amount is indicated, this reflects the actual amount that was paid.
For information about reporting periods, the most recent update, and the next update, visit the data availability page: https://profiles.health.ny.gov/pages/data_availability