Home health care agencies are complying with new regulations as the Conditions of Participation (CoPs) went into effect January 13. Providers are working to meet the new requirements for participating in the Medicare and Medicaid programs without the finalized interpretive guidelines (IGs), which offer more detailed information on certain measures.
The Centers for Medicare & Medicaid Services (CMS) did issue a draft of the IGs in October 2017 and asked the home health industry for feedback. Since then, the agency has also offered some supplemental information on the elimination of the definition for subunit home health agencies, providing additional clarity around one major issue in the new CoPs. However, there is still more information needed by agencies in the final IGs.
Fortunately, CMS has agreed not to implement any civil monetary penalties (CMPs) for the first year of the new CoPs, until Jan. 13, 2019. CMS also urged industry associations that providers should focus their compliance based on the regulations, not the interpretive guidelines. Most providers have had ample time to prepare for the changes, industry groups say.
“Most of them have done a lot of the homework in advance,” Joy Cameron, vice president of policy and innovation at industry association ElevatingHome, told Home Health Care News. “[They’ve done] the organizational structure [changes] to comply with the new CoPs, any grandfathering for administrator, etc. Those were the easy steps.”
If changes need to be made, those areas will most likely come to light in the next several weeks, she said, as providers come into contact with CMS surveyors.
Several overarching concerns remain for providers, including how surveyors will measure compliance. Furthermore, home health care providers are not the only entities that are waiting on guidance, according to Cameron.
“I think it’s very unfortunate…there is so much going on in health care that not all the components are necessarily ready at the selected start date,” she said. “I’m glad about the CMPs not being in place for a year, except in certain cases, but I do hope we see the guidance and it is spread far and wide. I want to make sure the assessors understand fully, too. Hopefully they will be sharing it very soon.”
ElevatingHome, along with other stakeholders and the National Association for Home Care & Hospice (NAHC), submitted comments to CMS on the IG draft.
One of the top remaining issues has to do with patient rights. Inconsistent wording throughout the CoPs has made it difficult for some providers to understand exactly what their requirements are, while some vague language has also left interpretation up in the air, including whether a patient or their legal representative needs to sign that they have received a copy of the notice of rights and responsibilities.
At the same time, the cost of the new CoPs was estimated to be $30,000 per agency, according to CMS. The most costly implementation is likely training all staff and management on the new rules, according to Peggy Patton, vice president of education at health care consulting firm Corridor Group.
“What will be the most costly is training the staff, making sure all staff across the organization understand what the changes are and what they mean to those individual staff members, and how it impacts them,” Patton told HHCN.
With the previous delay, agencies have had more time to get up to snuff, but other regulations across the industry make it a pressing time for home health providers.
“I believe that agencies have had enough time to prepare,” Patton said. “The caveat with that is there is so much noise within the industry, I think it’s hard for any given organization or leadership to know what they should focus on.”
Written by Amy Baxter