Home Health Agencies Anxious Without Final Guidelines for CoPs

Home health care agencies are still waiting on the finalized version of the interpretive guidelines (IGs) for the new conditions of participation (CoPs), which go into effect Jan. 13. The new regulations dictate how home health care agencies qualify to participate in Medicare and Medicaid. The CoPs had not been updated in decades prior to 2017.

A draft of the IGs was released in Fall 2017 to provider organizations, and some industry stakeholders submitted comments and feedback to the Centers for Medicare & Medicaid Services (CMS) for consideration. Associations and providers were waiting on further clarification on the guidelines with respect to a number of requirements, including personnel changes and a new patient bill of rights.

Fortunately, providers can expect that the finalized version will look similar to the draft, according to CMS.


“The final document, while waiting final clearance from our Office of General Counsel, will most likely not be vastly different from the draft provided to the HHA community earlier,” David Wright, director of the Quality, Safety & Oversight Group at the Center for Clinical Standards and Quality with CMS, said in an email that was shared with Home Health Care News.

CMS already delayed the implementation date of the CoPs by six months, pushing back the original date of July 13, 2017. The agency has stated it will not delay the implementation date again. Instead, CMS has suspended any civil monetary penalties (CMPs) until Jan. 13, 2019.

Bill Dombi, president of the National Association of Home Care & Hospice (NAHC), also does not expect the implementation date to be delayed again. In the first year of implementation, it is likely CMS will be somewhat flexible and aid agencies as they work to comply with the CoPs, he said.


“HHAs appear to be moving to establish compliance with the new CoPs to the best of their abilities given the absence of the final IGs,” Dombi told HHCN. “In doing so, the HHAs are expecting that CMS will conform to its stated policy that the new CoPs offer compliance flexibility and that any information gap that exists because of the absent final IGs will not not be exploited with unwarranted enforcement actions.”

However, even though no penalties will be imposed, some providers may be feeling more anxious without the finalized guidelines.

“My sense is that there is a lot of anxiety, and our members are using internal workgroups to make sense of everything,” Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told HHCN.

Still, agencies are “moving forward with good-faith efforts to comply rather than waiting for the final IGs,” Dombi said, adding that the association hasn’t heard of any “panic in that regard.”

Providers should rely more heavily on the regulations themselves rather than the guidelines, according to CMS.

“The HHA provider must meed the regulation not the IG,” Wright wrote. “The IGs do assist the surveyors to better understand the intent of CMS with the regulatory language, but the IGs are not regulatory and are not intended to provide a road map to minimum compliance.”

Written by Amy Baxter

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