Home Health Conditions of Participation: CMS Proposes Major Changes

Members | October 05, 2014

is a proposed rule that contains significant changes to conditions of participation in home health programs. The changes focus on improvements in the Quality Assurance Performance Improvement (QAPI) and patient-centered care process as well as changes in infection control procedures.

Medicare and Medicaid Program: Home Health Conditions of Participation (CMS-3819) is a proposed rule published in the October 9, 2014 Federal Register that contains significant changes to conditions of participation in home health programs.

The changes, which focus on patient-centered, well-coordinated care, include:

  • Improving communication systems and requirements for a data-driven quality assessment; and performance improvement (QAPI) program.
  • Enhancing the process for care planning, delivery, and coordination of services.
  • Streamlining regulatory requirements.
  • Revising to the Outcomes and Assessment Information Set (OASIS) requirements to update applicable electronic data transmissions to meet current federal standards. 
  • Expanding the current patient rights requirements to clarify the rights of each patient, the process for conducting patient rights violation investigations, and the process for addressing verified violations. 
  • Focusing the patient assessment requirement on each patient’s physical, mental, emotional, and psychosocial condition. 
  • Adding a requirement that a home health agency (HHA) must maintain a system of communication and integration to identify patient needs, coordinate care provided by all disciplines, and effectively communicate with physicians. This requirement would formalize and shape current, informal communication and coordination structures within HHAs to assure that patients receive the right care from the right discipline at the right time, with the ultimate goal of improving patient care outcomes and efficiency. 

  • Incorporating a new requirement for each HHA to develop, implement, and maintain an agency-wide, data-driven quality assessment and performance improvement (QAPI) program. The QAPI requirement mirrors activity already taking place in the HHA industry’s move towards a prospective quality of care approach that focuses on preemptive planning that continuously addresses quality improvement. It would be based on data already collected in the OASIS process, CMS-provided patient outcome and process reports, and numerous other industry efforts currently underway. 

  • Addressing a new infection control requirement that reflects current health care practices. It would require each HHA to maintain and document a program to prevent and control infections and communicable diseases. The infection control program would follow accepted standards of practice, including standard precautions, and educate staff, patients, and caregivers about proper infection control procedures. 
  • Condensing the requirements for nursing and therapy services into a single requirement that focuses on integrated patient care planning and delivery, and assures appropriate supervision of all services. 

  • Reinforcing the current home health aide supervision requirements by requiring additional supervision and training when an agency suspects that home health aide skills are insufficient. 

  • Clarifying the management and administrative structure of HHAs by allowing the administrator to designate an individual to act in his/her absence, which may be the skilled professional that is available during all operating hours.
  • Continuing to allow home health agencies to have branch offices, but eliminates “subunits.” Designating an HHA location as a “subunit” is a vestige of the old HHA payment system. Under the current payment system, having HHA “subunits” is no longer necessary. This change allows parent agencies to have greater control over all of their offices by placing all locations under the leadership and direct management control of the parent agency. The process for requesting the addition of a branch office would remain unchanged.

  • Proposing that the HHA administrator would have at least 1 year of supervisory or administrative experience in home health care or a related health care. The possession of an undergraduate degree would be a new option for establishing the qualifications of an administrator.
  •  CMS proposes to remove the requirements that the HHA send a summary of care to the attending physician at least once every 60 days.

  • Proposing that HHA must have a group of professional personnel to advise its operation.

  • Proposing that the HHA conduct a quarterly evaluation of its program via chart reviews.

CMS is requesting comments on the following sections of the proposed rule:

  • CMS believes some aspects of this proposed rule, such as requiring patient rights to be explained to a patient in the language and manner that he or she understands, would address the needs of vulnerable populations and contribute to eliminating health disparities. CMS is specifically requesting comments in regard to how its proposed requirements could be used to address disparities.

  • Methods to engage patients and the physicians who are responsible for their plans of care in the care planning and management process. Specifically, CMS is interested in ways to maximize the level of involvement of the physician who is most involved in the patient’s care prior to admission to the home health agency, and who is responsible for overall treatment of the condition(s) that led to the need for home health care.

  • CMS is also interested in ways to facilitate communication between the HHA and other physicians and practitioners (such as nurse practitioners and physician assistants) who may be furnishing care for issues that are not directly connected to the issues being addressed by the HHA.

  • CMS proposes that the HHA’s governing body would specify which undergraduate degree an HHA administrator would have to possess.

  • CMS delineates requirements for clinical records and discharge or transfer summary that must be sent within 7 days  to the primary care practitioner or other health professionals and 2 days to a facility.

  • Information collection requirements.

Comments must be received no later than 5 p.m. Eastern on January 7, 2015.

You may submit electronic comments on this regulation.

LeadingAge is in the process of reviewing the proposed rule, and we encourage members to submit comments.