Summary

How well does the Community Health Accreditation Program ensure that home health agencies adhere to Medicare conditions of participation? GAO found that the Health Care Financing Administration's (HCFA) evaluation of the program's effectiveness is inadequate. HCFA determined that the program's standards were similar to Medicare conditions of participation and, where differences existed, the agreed-upon modifications to the program's standards were documented. But other areas cited in the proposed regulation, such as examining the accrediting organization's staff and other resources, received little or no evaluation. While HCFA has sought to address these issues, it plans no further program evaluation because it believes that its earlier work, together with GAO's, adequately evaluates the program's ability to ensure that Medicare conditions of participation are met. But GAO's work was not intended to be a detailed evaluation of the program, and GAO believes that HCFA should do a comprehensive evaluation before granting the program deemed status.

GAO found that: (1) HCFA inadequately compared CHAP accreditation standards with Medicare conditions of participation; (2) where the CHAP standards were not comparable to the Medicare conditions, CHAP made appropriated changes in its standards to assure comparability and HCFA assured that those changes were appropriately documented; (3) HCFA did not examine CHAP survey files, did not fully evaluate the CHAP training process, did not obtain any information from CHAP about its staff size, and did not examine the CHAP financial statements; (4) HCFA has taken action to resolve those issues, by agreeing to change the CHAP time frames for notifying home health care agencies of survey findings to make them more comparable with HCFA and to train all CHAP surveyors; (5) CHAP has agreed to allow HCFA to perform on-site monitoring which will allow HCFA to determine whether CHAP resources hamper its ability to conduct an expanded number of surveys and to assure that CHAP meets Medicare conditions of participation; and (6) HCFA does not plan to perform any further evaluation of CHAP.