CMS Final Rule Outlining Home Health Conditions of Participation

Added on Jan 19, 2017

CMS Final Rule Outlining Home Health Conditions of Participation
Industry Edge January 2017

The Centers for Medicare & Medicaid Services (CMS) recently issued its final rule outlining the Medicare and Medicaid Conditions of Participation (CoPs) for home health agencies—the first revision CMS has made to the rule in more than 20 years. The new rule was long-expected after a draft proposal was introduced in late 2014.

Set to go into effect July 13, 2017, the new rule establishes minimum standards for home health agencies (HHAs) that want to serve Medicare and Medicaid beneficiaries, and includes requirements that CMS hopes will strengthen patient rights, encourage more effective communication between patients and caregivers and result in better outcomes reporting. The new CoPs are estimated to cost $293.3 million to implement in the first year and $290.1 million in subsequent years.

“Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies,” Dr. Kate Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, said in a press release.

The final rule requires that HHAs provide
  • A comprehensive patient rights condition of participation that clearly enumerates the rights of HHA patients and the steps that must be taken to ensure those rights
  • An expanded comprehensive patient assessment requirement that focuses on all aspects of patient well-being
  • Written information to patients and caregivers about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform and the name and contact information of an HHA clinical manager
  • An integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines and there is active communication between the HHA and the patient’s physician(s)
  • A data-driven, agency-wide quality assessment and performance improvement (QAPI) program that continually evaluates and improves agency care for all patients at all times
  • An infection prevention and control plan that focuses on the use of standard infection control practices as well as patient/caregiver education and teaching

Further, under an expanded patient care coordination requirement, the rule states that a licensed clinician must be responsible for all patient care services, such as coordinating referrals and ensuring that plans of care meet each patient’s needs at all times. The rule also includes a streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines, new personnel qualifications for HHA administrators and clinical managers, and revisions to simplify the organizational structure of HHAs while continuing to allow parent agencies and their branches.