The 6 Surveys for California Home Health & Hospice Agencies

If you're managing a Home Health or Hospice Care agency, you're likely overwhelmed, confused, and worried about the varying types of surveys and what happens if you don't pass. Failing one could put your entire business at risk. Ultimately, you may be wondering how you’re going to tackle this on your own. 

At The Home Health Consultant, we’ve seen the toll prepping for surveys takes on agencies when they’re already stretched thin. Just last year alone, we helped prepare and liaise over 200 surveys. The THC team specializes in helping agencies like yours navigate every kind of survey, because we’ve been there before. 

In this article, we'll review:

• A general breakdown of what a survey is (big picture)
• The difference between announced & unannounced surveys
• California licensure surveys
• Site Visit surveys
• Initial Medicare Accreditation surveys
• Triennial or Medicare Renewal surveys
• Focus surveys
• Complaint surveys
• What to do if your agency needs help navigating and passing surveys

By reviewing this informatio, you’ll take the first step to make sure your agency stays compliant, thriving, and profitable through surveys.

What Is A Survey?

A survey occurs when a government entity visits your agency’s office in person and, at times, may also visit patients' homes, to conduct an inspection. The primary purpose of the survey is to review your agency’s documents and procedures. However, each type of survey has specific nuances.

According to regulations set by the Centers for Medicare and Medicaid Services (CMS), upon entering your agency for any kind of survey, the surveyor will:

1. Present identification
2. Introduce the survey team to the administrator or designee
3. Explain the purpose of the survey they are conducting
4. Provide the estimated length of surveys 

What's the Difference Between Announced & Unannounced Surveys?

While there are many types of surveys, there is one consistent difference between all of them: whether they are announced or unannounced.

Announced surveys are scheduled in advance with the agency. For example, the California Licensure survey is an announced survey.

Unannounced Surveys are "surprise" surveys, where the agency knows the range of possible dates (the survey window) but not the exact date. The purpose is to observe the agency’s typical operations without allowing time for last-minute adjustments. Examples include initial enrollment accreditation surveys, focus surveys, and triennial surveys.

1. What Is a California Licensure Survey?

Every home health or hospice agency will experience a California Licensure survey when starting. These surveys are conducted by one of three national accreditors:

• Accreditation Commission for Health Care (ACHC)
• Community Health Accreditation Program (CHAP)
• The Joint Commission (TJC)

Surveys used to be conducted solely by government entities. However, as the industry has grown, the number of applications, and therefore surveys, has increased. This led the California Department of Public Health (CDPH) to outsource surveying to these three national accreditors. While many agencies opt to work with accreditors now, CDPH recently started conducting surveys again. 

What's the Purpose of a California Licensure Survey?

Your California licensure survey is critical because you cannot start seeing patients until you have your license. 

What do Surveyors Look For in a California Licensure Survey?

Each state has different requirements for surveys. California specifically requires a paperwork-based survey for California Licensure. For this survey, your agency administrator, alternate administrator, Director of Patient Care Services (DCPS), or Alternate DCPS must be present. In a California Licensure survey, the state will review all Human Resources (HR) files to ensure your staff is qualified. This survey aims to prove that your agency is following all policies and procedures regarding record-keeping and has all the documents, processes and staff in place to provide safe patient care.

Is a California Licensure Survey Announced or Unannounced?

A California Licensure survey is announced. This means you can schedule exactly when this survey will take place.

How Much Does a California Licensure Survey Cost?

To get a California Licensure survey, you will pay a fee of approximately $5,000. This fee is charged by one of the three national accreditors (ACHC, CHAP, or TJC) mentioned above.

What Happens When I Pass a California Licensure Survey?

Once you pass your survey, the California Department of Public Health (CDPH) will issue your agency a license. This gives your agency the ability to accept and treat patients, and move onto the next steps in the Medicare enrollment process.

2. What Is a Site Visit Survey?

A site visit is the quickest type of survey you will undergo, but that doesn’t mean it’s absent of its own nuances.

What's the Purpose of a Site Visit Survey?

A Site Visit is conducted to prevent fraud, abuse, and patient confidentiality breaches at Home Health and Hospice Care offices. This survey is one of the mandatory requirements to apply for the accreditation survey.

What Do Surveyors Look For at a Site Visit Survey?

During a Site Visit, the surveyor ensures that your agency is legitimate. This means checking in to make sure no other business or activities are being conducted at your office location. 

However, during a site visit, the surveyor will not review any of your agency’s work. The surveyor will visit the office and take photos of the front door, and sometimes the inside of your office. It’s more of a check-in to make sure your office is brick and mortar and where you said it is.

Is a Site Visit Survey Announced or Unannounced?

A Site Visit is unannounced, meaning you cannot schedule exactly when this survey occurs. In some cases, you may not even know a site visit has occurred. Sometimes, surveyors simply check the entrance to your office without even entering. There's a chance your site visit occurred, and you had no clue.

However, it remains essential that you have at least one person in the office when the surveyor comes. If you don’t, you risk survey failure, which can add months to your Medicare accreditation process.

How Much Does a Site Visit Survey Cost?

A site visit survey is free, as it is conducted by The Centers for Medicare and Medicaid Services (CMS).

To learn more about what you can expect in a site visit survey, check out our deep dive below.

What Happens if I Fail a Site Visit Survey?

The site visit survey is essentially a pre-survey to make sure you qualify for whatever you are applying for. For example, if you’re applying for accreditation, you will undergo numerous Site Visit surveys throughout the accreditation process. Failure to pass multiple site visit surveys will result in your application being rejected. In this case, you would have to start the accreditation process from scratch.

3. What Is an Accreditation Survey?

The next survey agencies typically undergo is an Accreditation survey. An Accreditation survey is similar to a California Licensure survey. However, the Accreditation survey differs for a few reasons.

What's the Purpose of an Accreditation Survey?

A large chunk of your patients will likely be on Medicare. Medicare is federal health insurance provided for anyone over the age of 65. Because a large number of patients in Hospice and Home Health Care are 65 or over, it’s important to make sure you qualify for Medicare Accreditation to be able to accept a wider variety of patients. 

Additionally, most insurance companies require Medicare accreditation as a condition of contracting. While agencies that are only licensed (not accredited) can legally service patients with private insurance, it will be impossible for them to get ‘in-network’ with insurance companies, thus being paid a much lower rate.

What Do Surveyors Look for in an Accreditation Survey?

The accreditation survey inspects the agency’s patient care, human resources, and administrative processes. To qualify for the Medicare program, your agency must meet all Medicare Conditions of Participation (COPs). These regulations are determined by the Centers for Medicare and Medicaid Services (CMS). 

At an accreditation survey, surveyors will: 

• inspect your office
• confirm the agency has serviced 3 discharged and 7 active patients
• review records 
• visit patient homes
• interview staff

While surveyors will primarily focus on Medicare COPs, each national accreditor has their own regulations as well. An Accreditation survey is generally on the longer side, spanning over two to three days. The more patients you have, the longer surveys tend to be.

If you fail your first Accreditation survey, don’t worry, the world isn’t falling apart! If your agency is not compliant with Medicare COPs, you will not pass, but you can redo the survey. However, you will have to pay to try the survey again, so avoid failing at all costs! It is often cheaper to hire consultants to help agencies pass, than to undergo this process multiple times.

If your agency is not compliant with the accreditor’s regulations, you must write, submit, and receive approval on a plan to fix your agency’s deficiencies. This plan is commonly called a Plan of Corrections, or POC for short. If your POC is approved, you will officially have your accreditation, and in tandem Medicare enrollment, approved.

Is an Accreditation Survey Announced or Unannounced?

An Accreditation survey is unannounced, meaning you cannot schedule an exact day and time. This is why once you apply for Medicare Accreditation, keeping your office staffed over the following weeks or months is essential. Surveyors who arrive at an empty office will cancel the survey and the agency will have to pay the cancellation fee.

How Much Does an Accreditation Survey Cost?

As mentioned above, the accreditation survey is conducted by one of the three national accreditors (ACHC, CHAP, or TJC). To get an accreditation survey, you pay one of the three national accreditors anywhere from $7000-$9000. This covers the accreditor’s cost of sending an out-of-state surveyor for 2-3 days to conduct the survey.

What Happens When I Pass an Accreditation Survey?

The provider application process typically takes between 3 to 9 months to complete, depending on the current backlog. Once the agency is found compliant with all Conditions of Participation (COPs), it can begin accepting Medicare for patient services from that date forward. Following this approval, the agency may also start pursuing contracts with private insurance providers if they choose.

However, there is a signifigant chunk of time between when your agency passes your accreditation survey and when your agency recieves its provider number. To learn how you can make the most of this time, check out our article below.

4. What Is a Triennial Survey?

You’ve officially passed your initial surveys, congratulations! You’re now set, at least survey-wise, to start accepting patients, including those on Medicare. But don’t get too ahead of yourself, surveys are an aspect of owning and operating home health and hospice agencies that never go away. The next survey agencies typically face is a Triennial survey.

What's the Purpose of a Triennial Survey?

A Triennial survey, as you may have guessed, occurs three years after your accreditation certificate and Medicare enrollment become valid. Unfortunately, once you pass the accreditation survey for the first time, you will inevitably have to undergo your triennial survey to renew your accreditation every 3 years, forever, as long as you want to continue billing Medicare.

What do Surveyors Look For in a Triennial Survey?

Over two to three days, one of three national accreditors will return to your agency to conduct another full accreditation survey. There are a few additional details the surveyors will want to look into now that your agency has been up and running for at least three years.

For example, the accreditor will review your agency’s administrative programs, such as your:

• QAPIs
• fall programs
• medication management program
• mergency management programs

and more, in much more detail since there are now 3 years of data and procedure to observe. On top of this, you will also have to meet all Medicare Conditions of Participation (COPs) again. 

Similar to the surveys above, a Triennial survey is also conducted by one of three national accreditors. Most agencies stick with their initial accreditor, as it’s easier to avoid updating all documentation, employee files, patient charts, and more.

Is a Triennial Survey Announced or Unannounced?

A triennial survey is unannounced, meaning you will not have the ability to schedule the survey. However, a triennial survey must occur within 6 months before the three-year expiration. This gives you more control over the period your triennial survey will take place.

How Much Soes a Triennial Survey Cost?

For your triennial survey, you will pay your national accreditor approximately $9,000-$15,000. Some accreditors charge less for this survey, but have an annual fee that will add up to this fee range. The cost of your survey will depend on your patient census, which will dictate how many days the agency will be surveyed.

What Happens When I Pass a Triennial Survey?

When you successfully pass your triennial survey, your accreditation and enrollment with Medicare are renewed for another 3 years. This allows you to continue accepting patients on and billing Medicare.

5. What Is a Focus Survey?

A focus survey is applicable when your agency makes any major changes to ownership or location. If you have no changes to the ownership or location of your agency, you do not need to worry about a focus survey.

What's the Purpose of a Focus Survey?

A Focus survey is important because it ensures your agency maintains and upholds Medicare Conditions of Participation (COPs), staffing needs, patient care, and more amid leadership or location changes. You will need a Focus survey in three situations:

• A Change of Ownership (CHOW)
• A Change Change of Location (CHOL) that is more than 20 miles from your approved office location
• OR a combination of a CHOW and CHOL (regardless of the distance)