CMS to Home Health: ‘Sky is Not Falling’ Over Lack of CoP Guidelines

While the spotlight across the home health care industry has recently shined on the upcoming payment reform, providers are still grappling with new requirements that went into effect in January—the Conditions of Participation (CoPs).

The new CoPs—the standards that agencies must follow to participate in Medicare—were the first update to the requirements in decades. And the changes were implemented without official interpretive guidelines (IGs) from the Centers for Medicare & Medicaid Services (CMS), raising alarm bells among providers, particularly as the cost to individual providers was estimated to be $30,000 to comply, according to CMS figures.

However, providers have had more than enough time to prepare and comply with the new CoPs without the guidelines, which are expected to come out in the next six to eight weeks, CMS officials from said during the National Leadership Conference in Washington, D.C. on March 9. The conference was organized by industry groups ElevatingHome, the Visiting Nurses Associations of America (VNAA) and the Alliance for Home Health Quality and Innovation.


CoP rollout

Home health care agencies did have time to review the new CoPs, and CMS even delayed the implementation by six months. A draft form of the IGs was released in late October to some stakeholders, who were able to provide feedback to CMS. The final version has still not been released. The IGs likely will clarify some of the requirements and specific language within the regulations, but their main purpose is to help surveyors, according to CMS officials. Surveyors will also base their work on the regulations, not the guidelines.

“There was a lot of concern about the fact that we did not have the interpretive guidelines out as of July in 2017,” Peggye Wilkerson, director, continuing care group, quality and safety oversight at CMS, said during a session on regulatory updates. “Technically, you don’t have to have interpretive guidelines to do surveys. You can do directly from the regulation. It was technically not an impediment to the new CoPs going live.”


CMS also did release a revised protocol for surveys following the Jan. 13 implementation date, which may have helped some providers understand how surveyors will evaluate their compliance to the regulations.

New requirements 

Providers also shouldn’t be too concerned over the lack of IGs because the regulations were not a total overhaul, as some other health care sectors experienced. There were only two completely new CoPs, Wilkerson argued, with updates to others.

“The sky is not falling,” she told providers. “These are not all new regulations. You’re very fortunate. Other sides of regulations that were done wrote all new regulations. That’s traumatic. That didn’t happen in home health—these are not all new regulations.”

Wilkerson outlined only two major changes for providers—the quality assessment and performance improvement (QAPI) mandate and infection control. To a lesser extent, providers will also have to update their emergency preparedness, she said. The QAPI provision requires agencies to show more data collection and performance improvemet projects to demonstrate if they are improving in certain areas.

Broadly, the infection control condition is a component within the agency’s QAPI program, with standards for infection control and prevention.

Providers and industry associations have sought more information around the patient rights provision. CMS also will not impose civil monetary penalties (CMPs) for the first year of the new CoPs, giving agencies some reprieve as they take steps to be compliant.

“The provider community was concerned the surveyors might not be as familiar with these regulations and CMPs might not be appropriate,” Wilkerson said. “We didn’t really agree with that but because there was significant provider concern, we agreed to do a one-year moratorium of the CMPs…We will impose the CMPs if there is an immediate jeopardy.”

CMS is still negotiating the final guidelines, Wilkerson said during the conference, and providers are awaiting their release.

Written by Amy Baxter

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