Matthew S. Arend
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CMS to Modernize Home Health Regulations

October 9, 2014Articles

On October 9, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule revising current conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs. This is the first time the home health regulations have been significantly revised since 1989. The Proposed Rule focuses on a patient-centered, data-driven, outcome-oriented process that promotes high quality patient care, while at the same time allowing HHAs greater flexibility in meeting quality care standards and eliminating unnecessary procedural requirements. Read the full text of the Proposed Rule here.

Home Health Services for the elderly and disabled are covered under the Hospital Insurance (Part A) and Supplemental Medical Insurance (Part B) benefits of the Medicare program. These services must be furnished by, or under arrangements with, a HHA that participates in the Medicare and Medicaid programs. The Proposed Rule would make extensive changes to the organizational scheme of 42 CFR Part 484, the regulation governing HHAs.

Through this Proposed Rule, CMS’s ultimate goal is to achieve a balanced regulatory approach by ensuring that a HHA provides health care that meets essential health and quality standards, while at the same monitoring and improving its own performance. The Proposed Rule would be a shift away from CMS’s “problem-focused” process of identifying health care providers who furnish poor quality care or fail to meet minimum Federal standards, correcting any inappropriate practice, and/or terminating that provider’s participation in the Federal health care programs. Rather, HHAs are encouraged to invest in measures to improve the quality of care provided to patients. The Proposed Rule supports this goal by eliminating certain process details from the current regulatory requirements. Additionally, the Proposed Rule reflects an effort to eliminate health disparities in vulnerable populations.

The Proposed Rule establishes the following four new CoPs:

1. “Patient rights” (found at §484.50) would emphasize a HHA’s responsibility to respect and promote the rights of each home health patient. The regulation would require HHAs to provide each patient with verbal notice of the patient’s rights in the patient’s primary or preferred language, expand the explicit rights of each patient, and specify conditions that must exist before a HHA could transfer, discharge, or terminate a patient’s care.

2. “Care planning, coordination of services, and quality of care” (found at §484.60) would incorporate an interdisciplinary team approach to providing home health services that focuses on the care planning, coordination of services, and quality of care processes. The rule would require all home health services furnished to patients to follow an individualized written plan of care signed by a doctor, provide requirements for what the to provide ongoing training and education regarding care and services rendered to the patient.

3. “Quality assessment and performance improvement” (QAPI) (found at §484.65) would charge each HHA with responsibility for carrying out an ongoing quality assessment, incorporating data-driven goals, and creating an evidence-based performance improvement program of its own design to affect continuing improvement in the quality of care furnished to its patients. The proposed rule would require proactive performance monitoring through an agency-wide, data-driven QAPI program under the supervision of the HHA’s governing body.

4. “Infection prevention and control” (found at §484.70) would require HHAs to follow accepted standards of practice to prevent and control the transmission of infectious diseases and to educate staff, patients, family members and/or other caregivers on these accepted standards. This would require the HHA to maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious diseases.

The Proposed Rule reflects a fundamental change in CMS’s regulatory approach – a change that largely focuses on a shared commitment between CMS and HHA providers to achieve improvements in the quality of care furnished to patients. CMS is taking a firm stance that HHAs must be actively participating and invested in their responsibility to improve performance. Home health providers are strongly encouraged to read the entirety of the Proposed Rule to understand how its proposed changes could impact their business. Comments on the Proposed Rule must be submitted to CMS by December 8, 2014.

For more guidance on this or other health care topics, contact Jennifer Mitchell at [email protected] or Matthew Arend at [email protected].