June, 2000

Informational Bulletin 00-11
MHC-16

Change of Ownership, Merger, and Termination Procedures Affecting Home Health Agencies and Outcome and Assessment Information Set Requirements

Purpose:

The purpose of this informational bulletin is to provide oversight guidance for OASIS implementation in three situations: where an HHA undergoes a change of ownership with a merger of two or more agencies; where there is a change of ownership with and without assignment of the seller's provider agreement; and where there is termination of the provider agreement, voluntary or involuntary.

As part of Health Care and Financing Administration's effort to achieve broad-based improvements in quality of care furnished by home health agencies through Federal programs, OASIS is one of the most important aspects of the HHA'S quality assessment and quality improvement efforts. The OASIS will assist agencies in improving their performance through quality of care determinations which are expected to be provided in Outcome-based Quality Improvement {OBQI} reports currently under development. As the individual patient assessments are linked to the individual HHA by the provider number, the OBQI reports will also be linked to the individual HHA by the provider number. It is imperative that the provider number be accurately reported on the OASIS assessments in all reports, including when HHAs undergo change of ownership, merger, or termination.

Change of Ownership - Mergers

In accordance with 42 CFR part 489.18 and SOM 3210, the merger of a provider corporation into another corporation constitutes a change of ownership. In the case of the merger of Agency A into Agency B, Agency A's provider agreement and its associated provider number are terminated. Agency B retains its existing provider agreement and provider number.

Agency A should provide the OASIS discharge comprehensive assessment for each discharged patient prior to or at the effective date of the merger. The surviving HHA ( Agency B ) should provide a Start of Care (SOC) comprehensive assessment for all persons it admits after the merger at the next skilled visit after the official merger date. The SOC assessment will allow eligibility for the home health benefit to be verified and care planning for the individual to proceed under Agency B. Subsequently, the assessments for all individuals being accepted for care by Agency B will be linked to the correct provider number to enable the agency to engage in quality improvement efforts with accurate OBQI reports.

Change of Ownership With Assignment

In accordance with 42 CFR Part 489.18 and SOM 3210, when there is a change in ownership and the new owner accepts assignment of the existing provider agreement, the new owner is subject to all the terms and conditions under which the existing agreement was issued, including compliance with the comprehensive assessment of patients condition of participation. The provider number remains the same if the new HHA owner accepts assignment of the existing provider agreement. The new owner is responsible for continuing to complete updates to the comprehensive assessment at the next scheduled time points.

Change of Ownership Without Assignment

In accordance with 42 CFR 489.18 and SOM 3210, when there is a change of ownership and the new owner rejects this assignment of the provider agreement, the provider agreement and the provider number of the former owner should be terminated. The HHA that is terminating its provider agreement and provider number should provide an OASIS discharge comprehensive assessment for each patient subject to OASIS standards prior to the effective date of the termination, according to 42 CFR 484. The new HHA will not be able to participate in the Medicare program without going through the same process as any new provider, which includes an initial survey. The HHA should meet all the Federal requirements, including applicable OASIS requirements as specified in the regulations, for all persons it accepts for care in order to participate in the Medicare program. This means that the HHA should provide a new SOC comprehensive assessment at the first skilled visit once it becomes Medicare - approved. In addition, updates to the comprehensive assessment should be provided at the other OASIS time points in accordance with 42 CFR Part 484, for all patients of the former owner it accepts for care.

Voluntary Terminations

In accordance with 42 CFR Part 489.52 and SOM 3046, a Medicare approved HHA may voluntarily terminate its provider agreement by filing a written notice of its intention to the Minnesota Department of Health who, in turn, notifies the HCFA Office. HCFA recommends that the HHA that is terminating its provider agreement should provide a discharge comprehensive assessment for each patient prior to the effective date of the termination.

Involuntary Terminations

The Regional Office may terminate an agreement with an HHA, in accordance with 42 CFR 489.53. HCFA will work with the HHA on a case-by-case basis to provide for the safe and orderly transfer of patients to another Medicare-approved HHA if appropriate. The Agency to whom the patients are transferred should provide a new SOC comprehensive as well as updates to the comprehensive assessment at the other OASIS time points.

The guidance and recommendations provided in this bulletin applies to all accredited HHAs that participate in Medicare and to HHAs that are required to meet the Medicare Conditions of Participation, including Medicaid HHAs.

If you have any questions regarding this Informational Bulletin, please contact in writing:

Minnesota Department of Health
Compliance Monitoring Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
P.O. Box 64900
St. Paul, Minnesota 55164-0900

Monday, March 28, 2011 at 09:45AM