Home Health & Hospice Week

‘Dramatic changes’ ahead for Conditions of Participation.

Nearly 20 years ago, Medicare proposed changes to home health agency conditions of participation that went nowhere. Will the ending be different for newly proposed COPs?

If these new COPs reach finalization, HHAs will have some new responsibilities on their plates regarding quality improvement, pa-tient transfers, and more.

The COPs proposed rule released Oct. 6 “would modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care to home health patients,” the Centers for Medicare & Medicaid Services says on its website. “The proposed regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes. This proposed regulation focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services; streamlines regulatory requirements; and builds a foundation for ongoing, data-driven, agency-wide quality improvement.”

Changes Substantial, White House Emphasizes

The COP rule published in the Oct. 9 Fed-eral Register “strengthens patient rights, improves communication, and focuses on patient well-being,” the White House says in a release about the revisions. “These updates to home health agency conditions of participation (CoPs) make substantial revisions to the existing CoPs.”

The COPs apply to about 12,500 HHAs serving about five million patients annually, the White House notes in its release.

In the rule, CMS proposes to establish four CoPs in addition to retaining the current requirements at §484.55, “Comprehensive assessment of patients”:

1. “Patient rights” would emphasize an HHA’s responsibility to respect and promote the rights of each home health patient.

2. “Care planning, coordination of services, and quality of care” would incorporate the interdisciplinary team approach to provide home health services focusing on the care planning, coordination of services, and quality of care processes.

3. “Quality assessment and performance improvement” (QAPI) would charge each HHA with responsibility for carrying out an ongoing quality assessment, incorporating data-driven goals, and an evidence-based performance improvement program of its own design to affect continuing improvement in the quality of care furnished to its patients.

4. “Infection prevention and control” would require HHAs to follow accepted standards of practice to prevent and control the transmission of infectious diseases and to educate staff, patients, and family members or other caregivers on these accepted standards. The HHA would be required to incorporate an infection control component into its QAPI program.

COPs Have New Emphasis

“There are some very dramatic changes in the regulation,” observes attorney Robert Markette Jr. with Hall Render in Indianapolis. At first glance, it appears “the removal of the group of professional personal and annual review COP and replacing it with the QAPI COP may be the biggest change,” Markette says.

“Based on preliminary review, I think the proposed regulations provide much needed specificity, detail and clarification regarding a number of points in the CoPs,” applauds Washington, D.C.-based health care attorney Elizabeth Hogue.

“The new proposed regulation’s new emphasis on patient rights, care planning, QAPI, and infection prevention and control reflects a more process and outcome of care approach incorporating the patient and caregiver perspective,” says Margaret “Peg” Terry with the Visiting Nurse Associations of America. “This new approach is in keeping with the overall health care focus with a continuous quality improvement emphasis,” Terry says.

This focus and the changes will be familiar to agencies that undergo accreditation, Terry adds.

Timeline: Will these COPs go the way of those that CMS proposed back in 1997? They “timed out” under the rule requiring finalization of proposed regulations within three years. CMS only finalized the OASIS provisions of those proposed COPs, CMS notes in this proposed rule.

“Due to the significant volume of public comments and the rapidly changing nature of the HHA industry at that time, this rule ... was never finalized,” CMS admits of the 1997 proposal.

This time, the White House says CMS will move to final rulemaking in 2015. Agencies have until Dec. 8 to comment on the rule. 

Note: The rule is at https://federalregister.gov/a/2014-23895.