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 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 48 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 correcton 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.