CMS recently revised Conditions for Participation (CoP) for home health agencies. It’s been over 20 years since the CoPs were drafted, and although CMS made some revisions since then, this is the first time the CoPs have been updated to focus on patient-centered and outcome-oriented quality standards.
Pegged at $284 million in annual costs, NAHC projects the costs at $30,000 per agency. While the per agency cost may not be high for agencies that already have systems and staff in place, for most, the new conditions may require enlisting new personnel and technology. Additional administrative burdens and costs aside, it’s crunch time in the industry as the timeline for implementation is set for July 13, 2017.
While some of the regulations remain much the same, here are a few highlights for the new mandates:
- An expanded patient’s rights section includes notification of a patient’s rights to the patient and the representative, including steps to ensure these rights are assured at all times.
- An interdisciplinary approach to care planning & coordination of services that evaluates and improves quality of care. The rule expands to allow for patient care coordination by a licensed clinician who will be responsible for patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.
- An integrated communication system that helps to ensure that HHAs communicate with a patient’s physician. CMS allows HHAs to use any form of communication including secure electronic communications to convey plan of care information to the patient. The integrated communication also helps ensure that patient needs are identified addressed, and coordinated across all areas.
- Infection prevention and control is a new requirement that places impetus on the use of standard infection control practices to aid prevention and control. “Control” would require a HHA to maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases. The program should be an integral part of the agency’s QAPI program.
- The Quality Assessment and Performance Improvement (QAPI) program is a data-driven, agency-wide quality assessment and performance improvement tool to evaluate and improve agency care for patients at all times.
- HHAs must educate and train staff, patients, and caregivers on current best practices. The new CoPs also redefine personnel qualifications for home health agency administrators, aides, and clinical managers.
- Skilled professional services are now streamlined to focus on relevant patient care initiatives and supervision across all levels. Skilled professional services include physician services, skilled nursing services, physical therapy, speech-language pathology services, occupational therapy, and medical social work services.
HHA Structure Revisions
The structure of the CoPs have been revised: Subpart A addresses general provisions, Subpart B tackles patient care, and Subpart C includes the organizational environment.
A vital revision in Subpart A addresses the structure of HHAs:
- Subunits currently operating under their own provider number will be regarded as distinct entities, which means they must independently meet all CoPs, have an independent governing body and an independent administrator.
- Subject to state laws and regulations, a subunit will be permitted to apply to become a branch of its existing HHA if the parent provides “direct support and administrative control” of the branch.
- New subunits will not be approved, instead only branch offices will be approved.
- State survey agencies and regional CMS offices will continue to issue approvals to HHAs applying for branch offices.
A CoP violation in one branch office will affect the entire HHA.
These are just a few of the highlights, but according to industry experts, implementing patient rights and QAPI programs within the deadline will be costly, time-consuming, and challenging.