CMS Proposes New Home Health Conditions of Participation
October 8, 2014 09:35 AM
The Centers for Medicare and Medicaid Services has issued the long-awaited Home Health Conditions of Participation (HHCoPs).
Home health agencies (HHAs) must meet the Medicare HH CoPs in order to participate in the Medicare program. Agencies that fail to meet any of the HH CoPs are at risk, at a minimum, for the imposition of a number of sanctions and potentially at risk for program termination.
Although CMS has made several significant revisions to the HH CoPs throughout the years, many of the current CoPs have remained unchanged since their inception. In 1997, CMS attempted to revise the HH CoPs with a proposed rule that focused on patient-centered outcome oriented quality standards. However, since CMS did not publish a final rule within the required three years time frame, the proposed rule was rescinded and CMS must issued anther proposed rule.
CMS maintains it commitment to revise the HHCoPs with a focus on a patient-centered, data driven, outcome-oriented process that promotes high quality of care, while at the same time eliminating unnecessary procedural burdens on HHAs.
CMS proposes to transform the HHCoPs using the following principles:
Develop a more continuous, integrated care process across all aspects of home health services, based on a patient-centered assessment, care planning, service delivery, and quality assessment and performance improvement;
Use a patient-centered, interdisciplinary approach that recognizes the contributions of various skilled professionals and their interactions with each other to meet the patient's needs;
Stress quality improvements by incorporating an outcome-oriented, data-driven quality assessment and performance improvement program specific to each HHA;
Eliminate the focus on administrative process requirements that lack adequate consensus or evidence that they are predictive of either achieving clinically relevant outcomes for patients or preventing harmful outcomes for patients;
Safeguard patient rights.
CMS proposes the most significant changes with the following new or revised CoPs:
The CoP for “Patient rights” emphasizes a HHA's responsibility to respect and promote the rights of each home health patient.
This revision expands the current patient right CoP at §484.10 by requiring the agency inform the patient of their rights both in writing and verbally; focuses on accommodating and complying with Limited English Proficiency requirements; and increases patients rights in regards to care planning. The CoP is organized into six standards: 1) Notice of Rights; 2) Exercise of rights; 3) Rights of the patient; 4) Transfer and Discharge; 5) Investigation of complaints; and 6) Accessibility.
The CoP for “Care planning, coordination of services, and quality of care” would incorporate the interdisciplinary team approach to provide home health services focusing on the care planning, coordination of services, and quality of care processes.
This proposed CoP combines and revises the current CoP at § 484.18 “Acceptance of patients, plan of care, and medical supervision” and the standard at §484.14(g) “Coordination of patient services”. The CoP is organized into five standards: 1) Plan of care 2) Conformance with physician orders; 3) Review and revision of the plan of care; 4) Coordination of care; and 5) Discharge and transfer summary. .
The CoP for “Quality assessment and performance improvement” (QAPI) would charge each HHA with responsibility for carrying out an ongoing quality assessment, incorporating data-driven goals, and an evidence-based performance improvement program of its own design to affect continuing improvement in the quality of care furnished to its patients.
The CoP for “Infection prevention and control” would require HHAs to follow accepted standards of practice to prevent and control the transmission of infectious diseases and to educate staff, patients, and family members or other caregivers on these accepted standards. The HHA would be required to incorporate an infection control component into its QAPI program.
The proposed CoPs for the QAPI program and infection control plan are new to HHAs and will likely require significant adjustments for most agencies in terms of resources and operations. Although many agencies have some form of a QAPI program and infection control plan, the proposed CoPs provide detailed components of what CMS expects from a HHA QAPI program and infection control plan.
The QAPI CoP replaces the current HHCoPs at §484.16 “Group of professionals and §484.52 “Evaluation of the agency’s program”. This CoP has been organized into five standards: 1) Program Scope; 2) Program data; 3) Program activities; 4) Performance improvement projects and; 5) Executive responsibilities.
The proposed CoP for an infection prevention and control program is organized into three standards: 1) prevention; 2) control; and 3) education.
CMS also proposes to consolidate and revise the CoPs at §484.30 Skilled nursing services, §484.32 therapy services; and §484.34 Medical social services, into one CoP titled “Skilled professional services.”
Rather than specifically identifying tasks, CMS proposes to broadly describe the expectations of the skilled professionals who participate in the interdisciplinary team. This CoP is organized into three standards: 1) provision of skilled services; 2) responsibilities of skilled professionals; and 3) supervision of skilled professional assistance.
Additionally, CMS has reorganized the order of the CoPs and assigned a new numbering system. The proposed CoPs are divided into three sections: A. General Provisions -§ 484.1 and §484.2; B. Patient Care-§484.40-§484.80; and C. Organizational Environment - §484.100- §484.115.
Lastly, CMS proposes to eliminate “subunits” designations and eventually require current subunits to be converted to either a parent agency or a branch.
NAHC continues with its analysis of the proposed rule for the HHCoPs and will provide additional insights in future NAHC report articles.
To view the proposed rule click here.
Comments are due 60 days from the October 9 publication date in the Federal Register.