Written by David Arroyo and Nancy Fitterer
For healthcare providers in New Jersey, mastering the nuances of Healthcare Service Firms (HCSFs) can be the key to successful operation and service delivery. This comprehensive guide, brought to you in partnership with CHAP and the Home Care and Hospice Association of New Jersey, offers in-depth insights into HCSFs, comparing them with home health agencies, detailing the steps for providing skilled services and guiding through Medicaid partnership.
What is a Healthcare Service Firm (HCSF)?
HCSFs, as defined by the Centers for Medicare & Medicaid Services (CMS), are entities providing a variety of healthcare and related services. In New Jersey, HCSFs offer both skilled and unskilled services regulated by the Division of Consumer Affairs.
HCSF vs. Home Health: Key Differences
Home health agencies, which are Medicare-certified and provide Medicare and Medicaid-covered services. HCSFs in New Jersey are authorized to provide both skilled and unskilled services; however, they are unable to take Medicare. Understanding this distinction is vital for those seeking services or looking to enter the healthcare market. Both home health and HCSF agencies offer private pay and accept commercial insurance.
|Healthcare Service Firm (HCSF)
|Home Health Agency
|Offers both skilled and unskilled services and may offer Medicaid-covered services.
|Primarily offers Medicare and Medicaid-covered services.
|Caregivers must be directly employed and supervised by a registered professional nurse of the firm.
Frequency – 1 in 30 days.
|Home Health Aides work under the supervision of a registered professional nurse provided by the agency.
Frequency – 1 in 14 days.
|Regulated by the NJ Division of Consumer Affairs and by the Department of Human Services (DHS).
|Regulated by NJ as a Home Health Care Agency or Hospice, under the oversight of the Department of Health (DOH).
|Certificate of Need (CON)
|CON is not applicable.
|CON is required.
Accreditation Requirement for New Jersey HCSFs
As of July 2019, a significant update to the regulations governing HCSFs in New Jersey came into effect. Accreditation became a mandatory requirement for all HCSFs to renew their license. This pivotal change highlights the state’s commitment to maintaining the highest standards of healthcare service delivery within the home setting.
The importance of Accreditation:
- Ensuring Quality of Care: Validates adherence to healthcare delivery best practices.
- State Regulations Compliance: Essential for legal compliance and uninterrupted service delivery.
- License Renewal: A prerequisite for HCSF license renewal in New Jersey.
- Medicaid Partnership: Accreditation is crucial for HCSFs intending to partner with Medicaid.
Get CHAP Accredited
CHAP Accreditation is a gateway to building a strong relationship with payors, while CHAP Standards ensure quality and ongoing compliance. The CHAP seal has been a symbol of trust and quality to consumers for over 55 years. When filling out your application for accreditation with CHAP, you will first add the service ‘Home Care’ and then fill in the last two questions in the census section with a ‘yes’ or ‘no’ based on the following information:
- HCSF Identification: Firms must specify their status as a healthcare service firm agency. This is essential for meeting the appropriate standards set by CHAP, in line with New Jersey state regulations.
- Medicaid Agency Status: Firms should also declare if they are a Medicaid agency, as CHAP’s New Jersey HCSF standards incorporate Medicaid requirements, critical for firms providing Medicaid services.
These steps are crucial for New Jersey healthcare service firms to comply with state regulations and uphold high standards of healthcare service.
Partnering with Medicaid
Working with Medicaid requires HCSFs to navigate a series of steps, including obtaining a Medicaid number and contracting with managed care plans.
Less than 400 out of 1,000 licensed HCSFs in New Jersey accept Medicaid. Partnering with Medicaid involves:
- Provider Application and Agreement
- Documentation Submission
- Program Compliance, which includes Electronic Visit Verification (EVV)
For detailed enrollment information, providers can visit the New Jersey Medicaid Provider Enrollment page, and select their provider type as ‘Home Health Agency/Personal Care Assistant/Private Duty Nursing.’
The Role of Certificate of Need (CON)
In New Jersey, being a Certificate of Need (CON) state signifies that it is not open to new agencies. Instead, surveys are conducted to determine if the state is open to considering CON applications, on a triennial basis. The CON program plays a critical role in ensuring that new or expanding agencies meet the needs of the community. However, it’s important to note that this process does not apply to HCSFs but is required for Medicare-certified home health agencies.
Identifying Your License Type
To understand your license type, consider the services you offer or intend to offer. For example, If you are providing unskilled personnel care or private duty nursing, and are regulated by the Division of Consumer Affairs and Department of Human Services, you likely operate under an HCSF license. For exclusively Medicare-covered services, a Medicare-certified home health agency license is required.
Registration Process for HCSFs
To register as an HCSF, providers must follow specific steps, including providing business details, identification numbers, ownership information, and healthcare practitioner supervisor documentation. Visit the New Jersey Division of Consumer Affairs page for a detailed inspection information guide and the Best Practices for Health Care Service Firms for advisory guidelines. Starting sometime in 2024, HCSFs will be required to send financial or audit information to the Division of Consumer Affairs. Regulations will be promulgated soon which will give more information on the process.
HCSFs are a crucial component of New Jersey’s healthcare system. Understanding these entities, their licensing, and their role in the healthcare ecosystem is essential for anyone involved in or affected by healthcare services in the state.
Stay informed about the evolving world of healthcare in New Jersey. Understanding HCSFs is just the beginning of your informed healthcare journey in the Garden State.
For more membership information, contact Susan Manders at Susan@homecarenj.org