CMS Issues Final Rule to Modernize Home Health Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule outlining the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies. Prior to the new finalized rule published Monday, the CoPs had not been updated in roughly two decades, when many of the requirements were first created.

The new rule was long-expected after a draft proposal was introduced in late 2014. The rule needed to be finalized within a three-year window and will be published on the Federal Register on January 13, 2017.

The conditions govern how home health agencies can qualify to participate in Medicare and Medicaid. The new CoPs are estimated to cost $293.3 million to implement in the first year and $290.1 million in subsequent years. The CoPs will be effective July 13, 2017, CMS stated in the rule.


“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,” Kate Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, said in a press release. “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 care from nearly 12,600 home health care angelicas participating in Medicare and Medicaid nationwide. Many industry groups, including the Visiting Nurse Associations of America (VNAA) and the National Association for Home Care & Hospice (NAHC), were generally supportive of the initiatives introduced in the draft proposal back in 2014.

“We do agree with many of the main principles the CoP, the conditions, were trying to get at, which was patient-centered care,” Joy Cameron, vice president of public policy at the Visiting Nurse Association of America (VNAA), said during a policy update call with members Monday. “It will be interesting to see the difference between the draft and now, because a significant amount of time has passed.”


At the same time, the groups were actively engaged during the comment period and hoped to make several changes and clarifications to the proposals.

Content of the Final Rule

Specifically, the finalized rule includes several updates to the CoPs. As summarized by CMS in its announcement of the rule, they include:

—A requirement for an integrated communication system that ensures patient needs are met, care is coordinated and that there is active communication between a home health agency and the patient’s physicians.

—A requriement for data-driven, agency-wide quality assessment and performance improvement (QAPI) program that evaluates and improves agency care for patients at all times.

—An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring plans of care meet patients’ needs.

Other CoPs that are included in the final rule related to ensuring documented communication, care coordination and a comprehensive patient assessment that ensures all aspects of patient wellbeing. The rule also requires clearly stated comprehensive patient rights and the steps to assure those rights.

During the proposal period, industry groups voiced their concerns over some of the new CoPs, including allowing enough time for a new QAPI program and an ample implementation period to comply with all new requirements. Groups also voiced concern over how new communication requirements are documented and what actions home health agencies must take.

A Long Time Coming 

As stated, the rule is the first update in decades of the fundamental requirements for home health agencies to participate in Medicare and Medicaid. However, the waiting was not for lack of trying. A proposed rule was published by CMS in early 1997 that would have revised the entire set of HHA CoPs.

Unfortunately, thanks to the sheer amount of comments and “rapidly changing nature of the HHA industry at that time,” the rule was never finalized in its entirety, according to CMS. Instead, just the OASIS rule was finalized in 1999.

Prior to publishing the proposed CoP changes in 2014, CMS took into account comments from the 1997 period, the agency stated.

Written by Amy Baxter

Companies featured in this article:

, ,