Preparing for Sharknado and Home Health Regulatory Hurdles

$1.93 billion. 741 pages. Those two numbers are significant markers for the home health care industry, which is facing an onslaught of regulations—and huge, looming costs if they come to fruition.

Specifically, $1.93 billion is the total financial impact home health care agencies might feel in the two to three years between the new Conditions of Participations (CoPs), the fast-approaching emergency preparedness rule, and the potential home health groupings model (HHGM). Among these three rules, agencies have had to work through 741 pages of rules and proposals.

With several major regulatory changes coming from the Centers for Medicare & Medicaid Services (CMS), home health care agencies are taking the rules one at a time and preparing for a more uncertain future.


Practicing for a Sharknado 

Among the most burdensome compliance issues for providers is the new emergency preparedness rule, which goes into effect November 15. The rule requires health care providers across 17 settings to meet new standards. After a wave of hurricanes and tropical storms, it’s easy to see why updates to these rules are mandated, but compliance can still come at a cost.

In Illinois, which saw some relief when CMS paused the pre-claim review demonstration (PCR) in April, agencies are deep in preparations for new emergency preparedness requirements and the CoPs.


“Our agencies are somewhere in between prepared and panicked,” Sara Ratcliffe, executive director at the Illinois HomeCare & Hospice Council, said during a panel discussion about regulatory impacts at the Home Health Care News Summit in Chicago last week. “We’ve learned that our agencies are resilient and nimble when it comes to rapid change, but there is no shortage of work with staff to be in compliance.”

And agencies are hard at work ahead of the emergency prep requirements, including going through drills of the unlikeliest scenarios—such as a Sharknado. A non-existent, natural disaster, a Sharknado consists of a waterspout that lifts sharks out of the water. While the concept comes from a made-for-television movie with the same name, panelist Dawn Futris, RN PI, said the situation is good practice for an emergency. Futris, the risk management and infection control manager at NorthShore University HealthSystem Home Health and Hospice, described the unusual scenario that the agency used at a recent drill.

“It was a tornado over Lake Michigan with sharks with toxic drool, and if you touched it, you would go into cardiac arrest,” she said during the summit, speaking of NorthShore’s drill.

At the very least, the scenario kept staffers engaged with its absurd concept. Home health and hospice workers are some of the best to help out in emergency situations, according to Futris, who said, “We know what’s out there in the community before anyone else.”


Home health agencies have slightly more time to prepare for the modernized CoPs, which will go into effect on January 13, 2018. However, agencies are still waiting on the interpretive guidance from CMS for more information for compliance, which will reportedly come out in December. The implementation date was already delayed once by six months, from the original date of July 13, 2017.

The Illinois Council is “not aware of any big push to delay [the rule] again,” Ratcliffe said, and providers are getting ready for the 2018 date. The delay of the guidance remains a thorn in the side of industry stakeholders.

“We’ve been working on CoPs after the final rule was published,” Cheryl Meyer, director of clinical excellence at Advocate Health Care, said during the panel session. “It’s human nature to want to defer it as long as you can. [We should] wait for the guidance. These CoPs are a modernization that has been planned by CMS, and it puzzles me why they don’t have the interpretive guidance—they’ve been sitting on these for years.”

While waiting for the guidance, Meyer still urges agencies to get squared away on the requirements without delay.

Providers in Illinois were still in the throes of PCR when the home health CoPs rule was issue, according to Futris, who said NorthShore “didn’t touch CoPs” until after PCR came out. However, they were prepared for a July 13 implementation date, in part because their electronic medical record (EMR) vendor had a process for the update.

Some aspects of the new CoPs will come at a big cost, including leaving a physical copy of the care plan with patients and family members, as well as the Quality Assurance & Performance Improvement (QAPI) standard for those providers that don’t have this system in place already.

Groupings Model

Perhaps the most burdensome—and worrisome—of these incoming regulations is the proposed home health groupings model, which was introduced via the prospective payment system 2018 update in July. The model threatens to cut $950 million in payments from the industry in 2019 alone.

The industry, including associations and agencies, have stepped up the fight against the proposal by taking lobbying efforts directly to Capitol Hill. Others are betting that the rule could undergo changes before it becomes finalized.

“OSF is in a wait-and-see mode,” Sheila Guither, manager of clinical practice and staff development at OSF Home Care Services, said. “Because the proposal is not budget neutral, there are concerns about cuts to payments and the devastating impact on home care in Illinois.”

However, OSF, which serves more than 8,000 patients daily, may be in a better position than other, smaller providers to handle the changes in the groupings model, which include a switch from the current 60-day episode of care to a 30-day period.

“As a larger organization, we are in a better place with HHGM and have the resources to do the billing twice as frequently.”

Even so, Guither predicts the proposal will affect patients negatively, as providers will have to make drastic changes.

Written by Amy Baxter

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