Despite giving agencies a reprieve this past summer by delaying the implementation of the new home health Conditions of Participation (CoPs), the Centers for Medicare & Medicaid Services (CMS) remains headstrong in upholding its effective date of January 13, 2018—despite not issuing a final version of Interpretive Guidelines.
With no guidelines, industry stakeholders have been campaigning for another delay in the implementation of the new CoPs, including Bill Dombi, president of the National Association for Home Care & Hospice (NAHC).
In a letter to CMS, Dombi requested the final rule be delayed until July 13, 2018, or six months following the issuance of the final interpretive guidelines, which could be released in December. CMS issued a draft of the guidelines in October.
“We would have thought that they [would be] finalized long before now, but they are not,” Dombi told Home Health Care News. “We’ve learned our lesson, and we’re not going to guess as to when they might come out in final form.”
On its part, however, CMS has taken measures to alleviate the industry’s woes concerning the new CoPs.
While the final interpretive guidelines are not yet available, for the first year following the effective date of the new CoPs—between January 13, 2018 to January 13, 2019—CMS will not impose any Civil Monetary Penalties (CMPs) on agencies who are taking actions to be compliant, according to Kate Goodrich, director of the Center for Clinical Standards and Quality at CMS.
“We will not impose [CMPs] on an any re-certification survey unless there is an identified Immediate Jeopardy situation,” Goodrich explained in her response letter to Dombi’s request.
Overall, this bodes well for the industry, according to Dombi.
“[This is] telling the providers that [CMPs are] something they’re safe from if they take reasonable steps. It’s an important actual concession on the part of CMS, because in 2016 there were 79 different [CMPs] imposed, and [they] can be very, very costly,” Dombi said. “The fact that CMS is saying they won’t use that hammer on providers of services is actually quite notable.”
In addition to this effort, on October 27, CMS shared a draft of the Interpretive Guidelines with its regional offices, as well as home health agency accreditation organizations and other industry stakeholders, including NAHC. As part of the move, CMS has established an e-mail inbox to receive commentary.
“The comments that were requested [by CMS] were submitted by November 15, and CMS is reviewing gathered comments from our members,” Dombi said. “At the moment, those comments are being evaluated and considered, and may lead to some changes in the final interpretive guidelines.”
While there is no time table on when the finalized guidelines will be distributed, NAHC does not expect any deviations from the draft form. For this reason, many agencies are beginning to take “full implementation steps,” according to Dombi.
“Any deviation would be unexpected because the draft guidelines really didn’t show anything that was notable in that regard. So, we don’t expect to be blindsided with something in the final guidelines,” he said.
In their best interest
Because of the resources it has made available to the industry—including the e-mail inbox and sharing of the draft guidelines—CMS is steadfast on its January 13 implementation date, according Goodrich.
“The availability of the tools for compliance … as well as the need for the flexibilities and improvements that are reflected in the new regulations, enable home health agencies to meet the January 13, 2018, implementation date in a manner that is in the best interest of home health agencies and their patients,” she explained in her response letter to Dombi.
The “flexibilities” in the draft guidelines, is a welcomed aspect and allows home health agencies to be compliant with the new CoPs, regardless of its final form.
“Home health agencies can take good-faith efforts to implement [changes], so long as the outcome is the outcome that the rule intends,” Dombi said. “I think the fact that [CMS is] coming out with interpretive guidelines to look very much like the rule language itself means that providers really can take a heart in CMS’ statements about being flexible and have choices of their own to achieve compliance, rather than having to prescribe to direction coming by way of those interpretive guidelines.”
Written by Carlo Calma