CMS Posts Conditions of Participation (CoPs) for Home Health Agencies

The Centers for Medicare & Medicaid Services (CMS) late Monday afternoon posted the final rule outlining the Medicare and Medicaid Conditions of Participation (CoPs) for home health agencies. The conditions govern how home health agencies can qualify to participate in Medicare and Medicaid. The new CoPs are estimated to cost $293.3 million to implement in the first year and $290.1 million in subsequent years. The CoPs will be effective July 13, 2017.

As we have reported before, this rule had not been updated in years. The new rule was long-expected after a draft proposal was introduced in 2014. The final rule will be published on the Federal Register on Fri., Jan. 13, 2017.

LeadingAge NY will be analyzing the 374-page rule to note any differences from the draft, and to see what comments recommending changes or clarifications to the proposals were accepted.

Highlights of the Final Rule

Specifically, the finalized rule includes several updates to the CoPs. As summarized by CMS in its announcement of the rule, they include:

• A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.
• An expanded comprehensive patient assessment requirement that focuses on all aspects of patient wellbeing.
• A requirement that assures that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform, and the name and contact information of a home health agency clinical manager.
• A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active communication between the home health agency and the patient’s physician(s).
• A requirement for 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.
• A new infection prevention and control requirement that focuses on the use of standard infection control practices, and patient/caregiver education and teaching.
• A streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines.
• An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.
• Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.
• New personnel qualifications for home health agency administrators and clinical managers.

LeadingAge NY will post our analysis and notify members of upcoming educational programs to review the rule and its impact.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871