New proposed COPs would mandate background checks of aides
April 1, 1997 4 minutes read
New proposed COPs would mandate background checks of aides
Not just for Medicare; COPs could affect your business, too
It’s supposed to affect only home health agencies that participate in the Medicare program. But the requirement in the proposed revised Conditions of Participation (COPs) that home health agencies conduct pre-employment background checks on home health aides could affect the private duty side, too, especially if a federal mechanism for the checks is implemented.
The Washington, DC-based Department of Health and Human Services (DHHS) proposed five new requirements in the COPs for home health agencies participating in the Medicare program. One of these is the criminal background check requirement. Another is the requirement that all Medicare-certified home health agencies implement the Outcomes and Assessment Information Set (OASIS), a standardized system for monitoring patient conditions and satisfaction. (For more information about the proposals, see p. 38.)
The proposals were published March 10 in the Federal Register and currently are on display at DHHS’ office in Washington, DC. In accordance with the Administrative Procedures Act, there will be a 90-day comment period before the DHHS weighs comments and publishes final rules.
Most of the proposal mirrors standards of the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, says Nancy J. Woods, RN, specialty services director for Contin-U-Care Home Health in Chattanooga, TN.
The criminal background check requirement, however, is a different story. "I can see how that could affect people, even more so in private duty," she says.
Although the requirement is stipulated for home health agencies serving the Medicare population, it may become accepted as an industry standard.
"Medicare is such a significant payer," says David Savitsky, executive vice president and COO of Staff Builders, Lake Success, NY. "Anything that it does will have an influence over the entire marketplace."
A lot of private duty companies do Medicare business anyway, he adds. "Why would they do [the checks] for a part of their business and not for the balance?"
A federal mandate means that a federal mechanism to check criminal backgrounds might be implemented, Savitsky says. This could entail agencies gaining access to a national criminal background database such as the one law enforcement agencies have.
"[Background checks] will become the standard since it will be so easy to check because of the mechanism. Private duty will then have to follow suit because everyone is going to demand that the checks be made."
The proposed rule will be beneficial to the industry since it would create a standard, Savitsky says. As it stands now, almost every state has or is considering its own law about checking criminal backgrounds. In addition, access to information is limited.
"The problem with background checks is that there is no easy way to do it," Woods says. "The system needs to make it where the information is readily accessible to the people who need it."
"Criminal background checks often are not that meaningful," Savitsky adds. "You can’t get into databases that have any [accurate] information or current information."
Once the federal government has established a plan for checking criminal backgrounds and Savitsky expects this to happen quickly it will be easy for the states to piggyback on it, says Savitsky. "It’s a popular and appealing type of legislation for states to pass."
More than a temporary problem
One question about the criminal background check rule is whether agencies will be restricted from hiring an employee or letting the person work until the background check is completed.
The need could arise, for example, for hiring eight people to staff a 24-hour case. Contin-U-Care Home Health now receives results of background checks by county within 24 hours. In the proposed system, if the federal requirement took 30 days and made no exception for the staffing situation, the results could be devastating.
"If I couldn’t work this person [in the meantime], I couldn’t do my business," Woods says.
Cost might also be a factor. Contin-U-Care pays $4 for its county checks. More extensive checks could cost up to $30 for each person, Woods says.
The proposed rule could mean a lot of different things depending on how it is written, she adds. "Does it mean federal or local checks, and where can the person not work [if a previous offense is found?]"
A writer on American Health Consultant’s on-line home care nursing bulletin board also had these concerns:
• Will there be standard guidelines as to what previous offenses are grounds for denying employment?
• Who will be responsible for making the decision about offenses such as shoplifting that occurred years ago? (To see how Texas handles these questions, see related story, at right.)
• Will results of background checks be covered by privacy or civil rights issues?
Savitsky also sees the OASIS outcomes reporting requirements as becoming the standard within the industry. "I think it’s almost going to become the Good Housekeeping Seal of Approval for agencies that are not required to do it," he says. "If you could go to an agency and hire a nurse who had quality standards and outcomes standards, then why would you go to an agency that doesn’t have it?"
The industry is reaching "a convergence and confluence of thinking that there needs to be more accountability in home health care," Savitsky adds. Having demonstrable outcomes may become a selling point for agencies.
"I think we’ll see agencies that will start to advertise and publicize the fact that they comply with the OASIS standards and that makes them a better agency," he says.
Good documented outcomes will be something you can hang your hat on, Savitsky says. "It’s something you can advertise and can tell people, particularly in the private duty market where you have people either being reimbursed by insurance or through their own resources. They are going to want to get better as quickly as they possibly can with the best possible outcome."
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