CMS Issues Sweeping New Rules For HHA Participation in Medicare/Medicaid

Home health agencies have six months to comply with sweeping new changes that will impact their ability to participate in the Medicare and Medicaid programs.

Earlier this month, The Centers for Medicare and Medicaid, released its final rules relating to the conditions of participation (CoPs) that home health agencies must meet to participate in the federal programs.

The final rules come more than two years after CMS initially proposed them and are designed to ensure that patients “get the highest level of patient-centered care from home health agencies,†according to CMS Chief Medical Officer Kate Goodrich.

There are more than five million Medicare and Medicaid beneficiaries receiving home health care from nearly 12,600 Medicare and Medicaid-participating home health agencies nationwide, according to CMS.

The final rule includes:

The final rule focuses on a patient-centered, data driven, outcome-oriented process that promotes high quality of care, while at the same time eliminating several unnecessary procedural burdens on home health agencies:

• A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.
• An expanded comprehensive patient assessment requirement that focuses on all aspects of patient wellbeing.
• A requirement that assures that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform, and the name and contact information of a home health agency clinical manager.
• A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active communication between the home health agency and the patient’s physician(s).
• A requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that continually evaluates and improves agency care for all patients at all times.
• A new infection prevention and control requirement that focuses on the use of standard infection control practices, and patient/caregiver education and teaching.
• A streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines.
• An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.
• Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.
• New personnel qualifications for home health agency administrators and clinical managers.

The rules, which take effect July 13, are expected to cost $293.3 million to implement in the first year and $290.1 million in subsequent years.

This is the first update of these rules in about 20 years. The Health Law Offices of Anthony C Vitale can assist your agency in navigating these new CMS rules while assuring compliance as a top priority.