CMS Proposes Revisions to Conditions of Participation for Home Health Agencies

October 7, 2014
Rick Gawenda

On October 6, 2014, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule detailing revisions to the Conditions of Participation for Home Health Agencies. This proposed rule represents the first update to the Home Health Agency Conditions of Participation since 1989. According to the CMS website, the provisions of the proposed rule include:

  • Includes revisions to the Outcomes and Assessment Information Set (OASIS) requirements to update applicable electronic data transmissions to meet current federal standards.
  • Expands the current patient rights requirements to clarify the rights of each patient, the process for conducting patient rights violation investigations, and the process for addressing verified violations.
  • Focuses the patient assessment requirement on each patient’s physical, mental, emotional, and psychosocial condition.
  • Adds a requirement that a home health agency (HHA) must maintain a system of communication and integration to identify patient needs, coordinate care provided by all disciplines, and effectively communicate with physicians. This requirement would formalize and shape current, informal communication and coordination structures within HHAs to assure that patients receive the right care from the right discipline at the right time, with the ultimate goal of improving patient care outcomes and efficiency.
  • Incorporates a new requirement for each HHA to develop, implement, and maintain an agency-wide, data-driven quality assessment and performance improvement (QAPI) program. The QAPI requirement mirrors activity already taking place in the HHA industry’s move towards a prospective quality of care approach that focuses on preemptive planning that continuously addresses quality improvement. It would be based on data already collected in the OASIS process, CMS-provided patient outcome and process reports, and numerous other industry efforts currently underway.
  • Addresses a new infection control requirement that reflects current health care practices. It would require each HHA to maintain and document a program to prevent and control infections and communicable diseases. The infection control program would follow accepted standards of practice, including standard precautions, and educate staff, patients, and caregivers about proper infection control procedures.
  • Condenses the requirements for nursing and therapy services into a single requirement that focuses on integrated patient care planning and delivery, and assures appropriate supervision of all services.
  • Reinforces the current home health aide supervision requirements by requiring additional supervision and training when an agency suspects that home health aide skills are insufficient.
  • Clarifies the management and administrative structure of HHAs by allowing the administrator to designate an individual to act in his/her absence, which may be the skilled professional that is available during all operating hours.
  • Continues to allow home health agencies to have branch offices, but eliminates “subunits.” Designating an HHA location as a “subunit” is a vestige of the old HHA payment system. Under the current payment system, having HHA “subunits” is no longer necessary. This change allows parent agencies to have greater control over all of their offices by placing all locations under the leadership and direct management control of the parent agency. The process for requesting the addition of a branch office would remain unchanged.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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