The Centers for Medicare and Medicaid Services (CMS) released a final rule on January 13, 2017, that modernizes home health agency Conditions of Participation (CoPs).
Many home health CoPs have not been comprehensively updated since the 1990s, when most of the requirements were first created. The CoPs govern how home health agencies can qualify to participate in the federal and state healthcare system.
Katie Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, stated that, “Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies. Today’s announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholder and medical evidence.”
Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health services and, according to a 2016 report issued by the Office of Inspector General (OIG), Medicare reimbursed approximately $18.4 billion for home health care in 2015.
Many of the themes incorporated into the final rule relate to patient-centered care, outcome oriented processes, and data driven results. Changes addressed in the final rule include:
· An expanded patients’ rights section that explicitly sets forth the rights of home health agency patients and requires agencies to provide patients and their representatives with a notice of those rights;
· New infection prevention and control section that focuses on standard precautions as set out by national and industry best practice standards;
· An expanded patient care coordination requirement;
· A new requirement for home health agencies to implement a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that will require continuous evaluation; and
· New personnel qualifications for home health agency administrators and clinical managers.
Among the above changes, the final rule incorporates additional provisions, which include: an expanded comprehensive patient assessment requirement, additional documentation requirements, and expanded supervision requirements. CMS estimates the new CoPs will cost roughly $293.3 million in the first year. With an effective date of July 13, 2017, home health agencies must be proactive in implementing the required changes to remain in compliance.
To read the full final rule please visit: https://www.federalregister.gov/documents/2017/01/13/2017-00283/medicare-and-medicaid-program-conditions-of-participation-for-home-health-agencies.