CMS Home Health Sanctions: Protect yourself with ACHC accreditation

Oct 29, 2013 6:52:26 AM / by ACHC

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With the implementation of the first phase of CMS sanctions for Home Health providers on July 1, 2013, agencies across the country are rightfully concerned about what resources are available to help them avoid steep penalties and ensure compliance with Medicare Conditions of Participation (CoPs). With fines totaling thousands of dollars per day on the horizon, a strong compliance program achieved through earning and maintaining ACHC accreditation is a key strategy. Since ACHC standards are written for providers, by providers, and incorporate the Medicare CoPs, agencies that choose to become accredited are taking an important step in reducing their risk.

In addition to the widely-recognized benefits of accreditation, the following are examples of how ACHC will help you avoid these sanctions:

  • All condition-level and standard-level violations cited during any on-site survey conducted by ACHC are not subject to the CMS sanctions.
  • For providers who have deemed status, CMS only conducts on-site surveys for complaint or validation purposes, significantly limiting the risk of an on-site visit during which sanctions could be imposed.
  • New Home Health agencies are frequently less familiar with CMS requirements. ACHC providers have access to a variety of resources, as well as a personal Accreditation Advisor and Surveyors with industry-specific experience aimed at helping you before, during and after the accreditation process.

Proper education of staff is also a key component to establishing and maintaining a strong compliance program, especially as it relates to the implementation of policy in direct patient care. During your on-site accreditation survey, your Surveyor will be evaluating staff providing patient care to ensure it is reflective of both professional standards of practice and agency policy. ACHC also provides audit tools to ensure compliance with essential standards related to personnel records, client charts and other required documentation and standards.


  • Directed Plan of Correction: CMS may impose a directed plan of correction developed by CMS or a temporary manager. If compliance is still not achieved, CMS could impose one or more additional sanctions until compliance is achieved or the agency is terminated.
  • Directed In-Service Training:  CMS could require HHA staff to attend in-service training programs if CMS determines that education would lead to correction of deficiencies. Providers of educational programs must be approved by CMS or the State, and the cost associated with the in-service training would be the responsibility of the HHA.
  • Temporary Management: CMS could impose the temporary management sanction if CMS determines that management limitations contribute to a HHA’s inability to correct deficiencies. The HHA would be required to pay for the salary and additional costs incurred.


Civil Money Penalties - CMS may impose a civil money penalty against an HHA for either the number of days the HHA is not in compliance or for each instance the HHA is not in compliance. Penalties can range up to $10,000 per day.

  • Suspension of payment for all new admissions - CMS may suspend payment for all new Medicare admissions regardless of whether the Condition Level deficiencies pose immediate jeopardy.


CMS-stated sanctions are applicable in the event of a condition-level deficiency, unless the standard-level deficiency is considered to impose significant harm to an individual or if an agency has a standard-level deficiency previously found to be a conditional-level deficiency. CMS will delay the application of civil money penalties, payment suspension and the Informal Dispute Resolution (IDR) process until July 1, 2014. For more information about the CMS sanctions, read the Federal Register, Vol. 77, No. 217 published November 8, 2012. Read more by downloading the CMS PDF › ›

Listen to the original Podcast from November 2012››

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Ready for accreditation? Contact ACHC at (855) 937-2242 to learn more.

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Topics: ACHC, CMS Sanctions, HHA, Home Health, Home Health Sanctions, Medicare Conditions of Participation


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