Home Health Conditions of Participation Summary of Changes for 2017

“The Centers for Medicare & Medicaid Services (CMS) released a final rule (CMS-3819-F) that modernizes the Home Health Agency Conditions of Participation (CoPs). The final rule, effective July 13, 2017, will improve the quality of health care services for all home health patients and strengthen patients’ rights. The regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes. This regulation focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services; and builds a foundation for ongoing, data-driven, agency-wide quality improvement. These changes are an integral part of CMS’ overall effort to improve the quality of care furnished through the Medicare and Medicaid programs, while streamlining requirements for providers. HHA (CoP) Final Rule (CMS-3819-F) at Federal Register through 1/12/2017” (Centers for Medicare & Medicaid Services, 2017)

This statement was issued by CMS after an almost three-year process that began with a draft proposal in late 2014. It announces the widely anticipated changes and updates in the 374 page Conditions of Participation (CoPs) which govern the participation of home health agencies in the Medicare and Medicaid programs. No updates have been made to the CoPs in about 20 years, so for many in the home health industry this type of readjustment is unprecedented, although not unexpected.

The intent of the updates is to reflect current best practices through a focus on patient-centered care, patient rights, and value and outcome-based care in an effort to promote high quality care for all, under all circumstances, in the home health arena. You can access the Medicare and Medicaid Program: Conditions of Participation for Home Health Agencies Final Rule here

Timing Matters

Before exploring the changes, a few dates should be noted:

One of the biggest challenges for all home health agencies will be achieving compliance with the new CoPs by July 2017. Evaluate your programs, assessments, policies, and processes now and be on the lookout for additional information, such as the Survey & Certification Guidance to Law & Regulations and the updated State Operations Manuel, Appendix B – Guidance to Surveyors. Not all changes can be contained in this document, but the next section will present a summary of the most important changes. Please refer to the Final Rule full document for additional information.

Important Changes, as Summarized by CMS (2017)

• Significant reorganization of CoP contents, clarification of terms, new definitions. Of particular note: changes in “subunit” and “branch”
• Requirement for integrated communication system ensuring patient needs are met, care is coordinated and that there is active communication between a HH agency and the patient’s physicians.
• Requirement for data-driven, agency-wide quality assessment and performance improvement (QAPI) program that evaluates and improves agency care for patients at all times. Far reaching change with implications for an agency’s governing body.
• Expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring plans of care meet patients’ needs.
• Rules related to ensuring documented communication, care coordination and a comprehensive patient assessment that ensures all aspects of patient wellbeing. NEW comprehensive assessment content requirements, including
  • Assessment of psychosocial and cognitive status
  • Assessment of risk level for hospital ED visits and readmission
  • Also: requirement that individualized POC include interventions to address/mitigate identified risk factors
• Requirement for clearly stated comprehensive patient rights and the steps to assure those rights. Note: NEW Standard mandating right to be informed of policies on admission, transfer and discharge in advance of providing care. Standard includes limitations on agency transfers, discharges, terminations of care.
• Requirement to provide additional documentation to patients and caregivers, including written information on specified topics
• Investigatory guidelines surrounding agency complaints
• Infection control organized under 3 standards (§484.70(a-c)). Agency expectations:
  • Maintain coordinated agency-wide program for surveillance, identification, prevention, control, investigation of infectious and communicable diseases
  • Program to be part of OAPI program
  • Expectation for agency to provide education on “current best practices” to staff, patients, and caregivers

Conclusion?

The changes require an integrated communication system with proper documentation, care coordination, QAPI programs, comprehensive patient assessments, and assurance of protection of patient rights, among other updates. Be proactive NOW in preparing for the implementation and expected compliance date…July is just around the corner!