With No Guidance, Another CoP Delay Could Be Coming

Home health care agencies are tentatively waiting on the interpretive guidelines from the Centers for Medicare & Medicaid Services (CMS) on the new Conditions of Participation (CoPs), which are currently set to go into effect January 13, 2018, and cost roughly $300 million.

With just a few months left to prepare, agencies are still on the hook for the guidelines, which will likely contain more details on how to operate and comply with some of the new requirements of the CoPs. However, CMS has yet to issue the guidelines, leading some to think that another delay in the implementation date is likely to come.

The update to the CoPs, which were already delayed once in April, includes several new measures for home health care agencies to follow to ensure they are eligible to provide Medicare-certified services.


“We, last week, asked for a [further] delay in the CoPs,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), said last week at the association’s annual conference and expo in Long Beach, California. “We have not had a response yet.”

Yet, Dombi expects that there is a solid 75% to 85% chance that another delay is coming on the effective date, he told reporters at the NAHC conference. Dombi arrived at that conclusion after hearing CMS itself was not fully prepared.

“We’re not getting solid buzz or rumors about when the guidelines will be out, but we confirmed this past week that there has not been any training yet of the surveyors on the CoPs,” Dombi said. “It’s the end of October and these take effect January 13, and there has been no training on it. That’s not the way to administer such a major wave in the program.”


Guideline Expectations

Specifically, NAHC and providers are hoping for more direction in the guidelines related to the patient bill of rights and transfer and discharge requirements in the new CoPs. The current rule for the finalized CoPs leaves some ambiguity

“When you look in the Federal Register for the CoPs, they talk about changes in the plan of care where you’re supposed to inform the individual, possibly just orally rather than in writing, in a conversational tone,” Dombi explained. “We would hope the interpretive guidelines give us better guidance than a ‘conversational tone.’”

NAHC is also looking for interpretations of the new patient bill of rights, which must be clear and accessible to patients and staff, and include more assessment components—psychological, functional and cognitive states of patients. The conditions require agencies to collect patient preferences and demonstrate progress toward identified goals, and also to identify family caregivers who can help provide care.

Without guidelines from CMS, NAHC has drafted its own version of a bill of rights to better inform agencies, according to Dombi, who stated NAHC will release their version if they don’t hear back from CMS within the next few weeks. NAHC sent their draft of the bill of rights to CMS, he said.

“The bill of rights [is] much more active, [more] robust in terms of patient communication,” Dombi said.

At this point, even if CMS releases a proposal of the interpretive guidelines and allows time for the industry to comment before finalizing a version, the current implementation date gives little time for stakeholders to fully prepare, according to Dombi.

Written by Amy Baxter

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