Home Health/Hospice Agency Compliance Consulting Services
Home Health Hospice Team Lead – Timothy E. Allen | Former Special Agent (U.S. Secret Service & DOJ-OIG)
Hospices can be public agencies, private organizations, or a subdivision of either. A hospice is supposed to care for terminally sick persons with emphasis on palliative care (relieving uncomfortable symptoms like pain). Hospices can also attend to patients with special needs (i.e., physical and psychological needs). Hospices must meet specific requirements to participate as such and have valid agreements as Medicare providers.
Home care is a term that encompasses professional support services allowing a person (i.e., aging or critically ill persons) to live safely at home. Home care is recommended for individuals managing chronic health problems, recovering from illness, or those with a disability or other special needs.
Home Health/Hospice State & Federal Regulations
Providers in the home health and hospice industry must comply with certain regulations. Generally, regulation surrounding home health and hospices focuses on standards of care in regards to federal entitlement programs like Medicare. The regulation is covered in sections of the SSA (Social Security Act) – Title 42-U.S.C.-1395d.
Other regulations, such as the U.S. CFR (Code of Federal Regulations), provide detailed Medicare compliance, including rules on quality reporting requirements of hospices and related providers. The regulation also highlights processes and appeals regarding drug coverage.
Our compliance consulting services can assist providers in meeting any state & federal regulations.
Put our highly experienced team on your side
Roger Bach
Former Special Agent (OIG)
Timothy E. Allen
Former Senior Special Agent U.S. Secret Service
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Maura Kelley
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Marquis D. Pickett
Special Agent U.S. Secret Service (ret.)
Medicare Hospice Program Participation
Providers interested in Medicare hospice program participation must comply with conditions of participation – conditions for standard state licensing. However, some states have other stringent requirements.
Medicare’s hospice benefit laws define hospice care (palliative care) as family, and patient care focused on optimizing a person’s quality of life by treating suffering, preventing it, or anticipating it.
Our compliance consulting services ensure providers follow Medicare’s hospice benefit laws, such as ensuring availability of trained volunteers as the need for additional support arises. Providers should also comply with interdisciplinary teamwork guidelines that highlight care needs for patients and their families.
We also ensure compliance with patient’s rights, such as the right to pain controls needed for prevention and treating pain. We ensure compliance with all Medicare’s hospice benefit laws, including the rights of patients and family members to understand terminal conditions.
The conditions for compliance are too many to be understood and recalled. That’s why hospice providers need compliance experts like us with a thorough understanding of regulations like 42-CRF-Part 418, among other compliance laws.
Summary of Conditions for Hospice Providers
Hospices that seek compliance can implement the following information on different aspects.
Notices: Patients or representatives must get written and verbal notices stipulating their responsibilities and rights. These notices must be issued during initial assessments.
Right to be heard and respected: Patients in hospices must be heard and treated with respect. Patients and their representatives should be able to voice grievances on treatment or care without being discriminated or subjected to retaliatory action for exercising such rights.
Reporting and investigating violations: Hospices also need to have systems in place that ensure alleged violations like neglect, abuse, mistreatment etc., can be reported and investigated promptly.
Right to treatment: Patients in hospices have the right to pain management (to receive preventative pain medication or medication for addressing pain). Patients can also choose physicians, and take part in developing their own care plans and receive information pertaining to services that are covered/not covered by their benefit.
Patient assessment: Registered nurses working in hospices must do initial patient assessments within 3 days, followed by a comprehensive assessment (done by a hospice’s interdisciplinary group) within five days. Comprehensive assessments must contain data that allows measurement of outcomes. Providers must measure and document assessment on a recurring basis.
Corporate Investigation Consulting can assess and ensure compliance for the above and more for you to avoid legal problems. Our assistance includes compliance with state hospice care laws.
We have the capacity to guide providers on state hospice care laws. Corporate Investigation Consulting has home health/hospice compliance consulting experts nationwide.
State Hospice Care Compliance
Different states have different regulations regarding hospice care. These regulations are present in administrative codes. They address requirements for contracting hospices under state Medicaid programs. The regulations also offer guidelines relating to patients.
Texas hospice compliance: Title 40-chapter 30 – Texas Administrative Code highlights eligibility compliance, general contracting requirements, terminal illness certification guidelines, rules for revoking hospice care elections, and more.
California hospice compliance: In California, hospices are required to avail their services on a 24/7 basis and offer bereavement counseling to significant others.
Illinois hospice compliance: In Illinois, hospice programs are licensed as volunteer or comprehensive programs. Patients must be informed about the services they receive and changes to their prognosis. They also have a right to privacy and review care plans.
Pennsylvania hospice compliance: In Pennsylvania, licensed hospices must get Medicare certification first and meet other state definitions of hospices.
Corporate Investigation Consulting understands all state codes regarding hospice care laws. We can help providers comply with the above state hospice regulations and more. Talk to us: 866-352-9324.
Patients and their representatives or family members also need to understand hospice care laws. When a loved one has a short time to live, hospice care offers emotional support, pain management, bereavement, counseling, and more. However, this care must be at par with certain regulations and guidelines.
Talk to Corporate Investigation Consulting (866-352-9324) if you don’t understand any of these rules or have specific concerns. We have legal experts who can make sense of the vast subject of hospice compliance consulting.
Home Healthcare Compliance
We can also ensure home healthcare providers adhere to all applicable rules when treating a patient’s illness or injury from their home.
Home healthcare staff should follow simple rules such as seeing you as per your doctor’s recommendation. Patients should also be updated regularly about their progress. Home health service agencies also need to schedule appointments immediately after a doctor’s orders to commence care.
We understand the obligations of home healthcare providers to the letter. We can advise providers on compliance issues from licensing to reporting and patient care to help them avoid legal and reputational risks. Our support also extends to patients that suffer harm or loss because of non-compliant home healthcare providers.
Get a free-confidential compliance consulting session with our dedicated experts now – call 866-352-9324 or contact us online.