Home Health & Hospice Week

Change would save HHAs $55 million per year, CMS estimates.

A new Home Health Condition of Participation requirement may get cut, thanks to the Trump administration’s efforts to reduce regulatory burden for providers.

In its new proposed rule aimed at reducing Medicare providers’ burdens, the Centers for Medicare & Medicaid Services proposes scrapping the requirement at 484.50(a)(3), which “requires HHAs to provide verbal (meaning spoken) notice of the patient’s rights and responsibilities in addition to the requirement to provide such notice in writing.”

CMS proposes “to delete the requirement that HHAs must provide verbal notification of all patient rights,” the rule says. “This change would be consistent with the ... requirements for other outpatient provider types, such as hospices, ambulatory surgery centers, and community mental health centers, for which written notice ... is the only requirement.” HHAs still will have to abide by the verbal notification requirements in section 1891(a)(1)(E), which cover the following information:

• All items and services furnished by (or under arrangements with) the agency for which payment may be made under Medicare,
• The coverage available for such items/services under Medicare, Medicaid, and any other Federal program of which the agency is reasonably aware,
• Any charges for items and services not covered under Medicare and any charges the individual may have to pay with respect to items and services furnished by (or under arrangements with) the agency, and
• Any changes to the charges or items and services set forth in the previous bullets. HHAs’ arguments against the requirement swayed CMS, according to the rule. In 2018 rulemaking, commenters said “the requirement to provide verbal notice of all rights to patients and their representatives was overly burdensome to the HHA clinicians that would be required to discuss the notice with patients when they could be furnishing hands-on patient care during that time, and lacked evidence that such explanations would result in improvements to patient safety or care.”

Eliminating the patient rights verbal notice requirement “will certainly be appreciated,” expects consultant Kathy Roby with Qualidigm based in Wethersfield, Connecticut.

The new requirements have been tough. Under the current requirements, “they exceed a normal person’s ability to learn when combined with med teaching, safety, etc., which is usually taught on admission,” especially for high-risk medications, judges consultant Julianne Haydel with Haydel Consulting Services in Baton Rouge, Louisiana. “It adds a lot of time to the visit, which exhausts patients and is burdensome to nurses,” Haydel notes.

The elimination “will be a time saver on the initial visit and is practical,” praises attorney Liz Pearson with Pearson & Bernard in Edgewood, Kentucky. “There is only so much info a patient and/or patient rep can ingest. Providing them the written notice is preferable and aids in assuring the other patient engagement issues can be fully addressed such as involvement in plan of care, establishing patient goals, etc.,” Pearson tells Eli.

On the other hand: While consultant Pam Warmack with Clinic Connections appreciates the burden reduction, she does worry that patients won’t understand their rights as well under the proposed policy. “The truth is that patients rarely read the admission documents provided,” Warmack says. “If they do read them, they often do not understand them. If a clinician doesn’t talk to the patients about their rights, I seriously doubt the patient ever has a real understanding of their rights.”

Compromise: A good alternative might be for CMS to require verbal notice of patient rights, but not within the current “prescriptive time frame,” Warmack suggests.

This change is the only HHA-specific one proposed that has an attached savings. CMS estimates eliminating the verbal notice requirement will save HHAs $55 million annually. That may be an overstatement, Pearson offers. “I don’t believe CMS’ estimates are realistic,” she says.

And remember: The change “will require an educational effort to make the actual substance of the change evident to the providers,” Roby points out. “That may make it harder for providers to appreciate the moderate relief obtained here.”

Note: Comments on the proposals are due Nov. 19. Instructions for commenting are in the rule at www.gpo.gov/fdsys/pkg/FR-2018-09-20/pdf/2018-19599.pdf.