Regulatory Roundup: Home Health Medicare Conditions of Participation

What’s happening?

Who’s affected?

• All Medicare- and Medicaid-certified home health agencies (HHAs)

Highlights from the final rule

Requirements for the 60-day physician summary, professional advisory council and quarterly record review have been eliminated and replaced with new conditions requiring Quality Assessment and Performance Improvement (QAPI), a strengthening of patient rights, and infection control programs.

• Patient Rights:
  • Information for patients and their caregivers about the care being delivered must be understandable and conveyed in the individual’s primary or preferred language
  • Patients and caregivers must receive education and training related to the specific patient’s care and treatment, including written instructions outlining medication schedule/instructions and details on the patient’s visit schedule
• Quality Assessment and Performance Improvement (QAPI) Program: Individualized QAPI programs need to be developed and implemented by HHAs to continually evaluate and show measurable improvement in indicators that will improve health outcomes, patient safety, and quality of care
• Infection Prevention and Control Program: HHAs are required to develop an infection prevention and control program that focuses on the use of standard infection control practices and patient/caregiver education and training. The program must include a method for identifying infectious and communicable disease problems and a results-oriented action plan
• Supervisory/Staffing Requirements: To help streamline care across various disciplines, HHAs must ensure that skilled professionals providing services (e.g. skilled nursing services, physical therapy, speech-language pathology services, occupational therapy, social work services) to HHA patients participate in the care coordination activities

Why are these changes happening?

The updated CoPs modernize the existing requirements to improve home health quality of care. The requirements have not undergone a comprehensive review in over 10 years.

Reflecting changes in the patient population and evolving care delivery models, the ruling contains major modifications in the HHA CoPs that parallel the finalized requirements for long-term care facilities, which were released in October 2016, demonstrating CMS’ commitment to coordinated, patient-centered care. According to CMS, “The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements.”

How should you prepare for this CoPs regulation?

Due to many of the rule’s more explicit requirements for the home health industry (e.g. patient notification and education) HHAs may need to shift personnel and resources and adapt their current practices to meet the requirements in this final rule.

• Develop your QAPI program: QAPI merges quality assurance (QA) and performance improvement (PI) in improve clinical quality and patient/resident quality of life. HHAs have flexibility when designing their QAPI programs, but CMS has also outlined key elements to include in QAPI, including recommended steps that can be used when making quality improvement plans

*CMS defines Immediate Jeopardy as “A situation where noncompliance with federal laws and regulations is likely to cause serious injury, harm, impairment, or death to residents, patients or clients.”