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Highlights

Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) process for surveying home health care agencies and certifying them for Medicare participation.

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Recommendations

Matter for Congressional Consideration

Matter Status Comments
Congress should amend the Social Security Act to require the Secretary of Health and Human Services to develop and enforce training standards for all persons who perform high-technology medical procedures in the home that present a risk to Medicare beneficiaries.
Closed - Not Implemented
There has been no action taken on this recommendation, and there does not appear to be any potential for action in the foreseeable future.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services 1. The Secretary of Health and Human Services should direct the Administrator, HCFA, to establish standards for selecting samples of patient records for review during surveys that require: (1) the surveyor, rather than agency staff, to control the record selection process; (2) a random sampling selection process; (3) a sampling plan that provides for selecting enough records to have sufficient confidence in the conclusions drawn about agency performance; and (4) coverage of all services the agency offers.
Closed - Implemented
Revised instructions covering survey methodology and procedures have been issued to the state survey agencies.
Department of Health and Human Services 2. The Secretary of Health and Human Services should direct the Administrator, HCFA, to develop specific guidelines to clarify the circumstances under which state surveyors should examine branch offices and the qualifications of contract personnel in order to determine agency compliance with the conditions of participation.
Closed - Implemented
Revised instructions covering survey methodology and procedures have been issued to the state survey agencies.
Department of Health and Human Services 3. The Secretary of Health and Human Services should direct the Administrator, HCFA, to conduct field tests to determine whether survey guidance is sufficient to ensure that surveyors reach consistent conclusions when conducting surveys.
Closed - Implemented
The Omnibus Budget Reconciliation Act of 1987 directed HCFA to report to Congress on implementation of required changes to the survey process. HCFA is contracting an 18-month study which will analyze the new survey process. The report to Congress should be made by March 1994.
Department of Health and Human Services 4. The Secretary of Health and Human Services should establish a procedure to give state surveyors relevant information concerning agency performance that fiscal intermediaries and peer review organizations develop.
Closed - Implemented
HCFA developed instructions that direct fiscal intermediaries and peer review organizations to provide relevant information to state survey agencies.
Department of Health and Human Services 5. The Secretary of Health and Human Services should direct the Administrator, HCFA, to direct HCFA central and regional offices to increase the use of Medicare/Medicaid Automated Certification System data as a means of monitoring and comparing the performance of state survey agencies.
Closed - Implemented
HCFA has performed studies using Medicare/Medicaid Automated Certification System data that compare the performance of state survey agencies.
Department of Health and Human Services 6. The Secretary of Health and Human Services should direct the Administrator, HCFA, to adopt standard survey forms to be used by state surveyors that will provide enough information on records reviewed during the survey to allow HCFA to assess the adequacy of records review and the validity of conclusions reached.
Closed - Implemented
Standard survey forms have been prepared and issued to the state survey agencies.
Department of Health and Human Services 7. The Secretary of Health and Human Services should direct the Administrator, HCFA, to direct HCFA regional offices to: (1) review all documentation submitted with a sample of surveys conducted by each state survey agency to determine whether the states are complying with standards for record selection and sampling; and (2) discuss the results of this review in the regional offices' periodic evaluations of the state agencies.
Closed - Implemented
HCFA has instructed its regional offices to review documentation for a random sample of surveys and for all surveys meeting certain criteria.
Department of Health and Human Services 8. The Secretary of Health and Human Services should direct the Administrator, HCFA, to revise the assumptions used in developing budgets for agency survey operations to recognize the changes in the survey process that recent legislation mandates and that GAO recommends. In particular, the budget process should recognize that surveys of agencies with large case loads, at which larger samples of patient records should be reviewed, will require more time and resources.
Closed - Implemented
HCFA has issued revised guidance concerning state survey agency budgets to its regional offices.

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