Home Health Sector Faces Short Deadline for Sweeping New Rule

The home health industry is about to be inundated with new regulations after a long-expected update of the Conditions of Participation (CoP) was released by the Centers for Medicare & Medicaid Services (CMS) Monday.

With the introduction of the final rule that defines what is needed to participate in the Medicare and Medicaid programs, home health agencies and industry groups are wading through numerous changes. With an effective date of July 13, 2017, agencies have roughly six months to comply. One area of concern is the implementation time, which is much shorter than what was requested by agencies and home health associations during the comment period.

“We asked for 12-18 months lead time,” Bill Dombi, vice president for law at the National Association for Home Care & Hospice (NAHC), told HHCN. “We are assessing whether the 6 months is sufficient, given the rule outcome.”


When the rule was introduced in proposal form at the end of 2014, industry associations, including NAHC and the Visiting Nurse Associations of America (VNAA), asked for more than a year after publication of the final rule for agencies to comply. VNAA also asked for a a one-year period during which CMS would not sanction home health providers that are not in full compliance. Now, with a short timeline, associations are prepping members on their new requirements.

“With the quick six-month implementation date, VNAA is working to ensure that our members are fully briefed and prepared to comply with the July 13th deadline,” Joy Cameron, vice president of public policy at VNAA, told HHCN.

Home health agencies agree that the six-month period may be too short.


“[A] six-month implementation date is too soon for such a dramatic change in the CoPs,” Ken Miller, clinical educator of New York-based Catholic Home Care, told HHCN.

Despite the short timeline, not all industry groups are bracing for burdensome changes.

“Given the very significant scope and nature of the changes, we hope CMS will exercise discretion and flexibility on enforcement for a reasonable period of time after July 13, 2017 in recognition of the need for significant structure, process and training changes that agencies will need to make to comply,” Teresa Lee, executive director at the Alliance for Home Health Quality and Innovation (AHHQI), told HHCN.

Positive Changes

In fact, AHHQI is generally supportive of the changes, which had not been updated in roughly two decades. The Alliance also noted that the final rule did take into account some of their comments from the proposal period in 2015.

“The Alliance supports the newly revised conditions of participation and the focus on patient-centered care, patient rights and value and outcomes-based care,” Lee said. “CMS’s final rule also incorporates several recommendations made by the Alliance.”

The final rule aims to change all conditions of participation and add several new ones, with the potential to cause additional administrative burdens and costs. One such area that association groups are looking into relates to organizational structure and additional communication requirements.

Fortunately, it appears that at least some concerns voiced by home health care groups have been heard in the final rule.

“We are please that CMS will permit HHAs to use any form of communication, including secure electronic communications, to facilitate patient knowledge and understanding of the care being delivered,” Lee told HHCN. “This is consistent with the Allaince’s recommendation to permit electronic transmission of the plan of care information to patients and allowing for the flexibility on the means one might use.”

One of the new CoPs mandates expanding care coordination between a patient’s physician with an “integrated communication system that ensures that patient needs are identified and addressed” and that care is coordinated across all disciplines, according to CMS. The expansion requires home health agencies are in “active communication” with the physician(s).

Introducing more regulations between physicians and home health agencies could prove to be tricky; regulations related to the Pre-Claim Review Demonstration (PCRD) that require documentation from a physician earlier in the claims process has been challenging for some participating agencies. The issue even became a focal point in CMS’ education outreach to improve PCRD affirmation rates.

Documentation Changes

Another major change in the final rule centers on documentation requirements. While home health agencies have already seen their documentation requirements change rapidly over the past few years, thanks to initiatives within the IMPACT Act and Pre-Claim Review Demonstration (PCRD).

Under the new CoPs, home health agencies are required to provide additional documentation to patients and caregivers, including 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.

Agencies also have to provide comprehensive patients’ rights that clearly enumerate the rights of home health patients and steps to ensure the rights are assured at all times.

“Of particular interest for us are the patient rights changes, which could be a significant implementation and operational burden for home health agencies,” Dombi said. “In addition, we are focusing on the changes related to infection control and the discharge summary.”

However, the language related to patient rights appears to have softened from the initial proposal. Specifically, CMS clarified that home health agencies are not expected to provide this in writing in every language, the Alliance told HHCN.

Furthermore, there is a new requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that evaluates and improves agency care for patients.

“I think the biggest challenge is the development and implementation of the QAPI regulations,” Miller told HHCN. “New conditions that will likely be costly and burdensome are the QAPI.”

While it remains to be seen which is the most costly new provision, there’s no doubt that the new CoPs come with a significant pricetag: an estimated $293.3 million in the first year, according to the final rule.

Written by Amy Baxter

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