Home Health & Hospice Week

Use this advice to minimize the impact of the new requirements.

Feeling overwhelmed by one of the CoPs’ biggest changes? You’re not alone.

But now you have six more months to make sure you’re in compliance — and avoid potentially punishing survey results, such as alternative sanctions ranging from Civil Money Penalties of up to $20,000 per day to payment suspensions.

Consider this advice from the experts to be sure you’re ready when the Jan. 13 implementation deadline for the new Conditions of Participation hits:

1. Start today. “There is a lot of work to prepare for the CoP changes,” stresses Judy Adams with Adams Home Care Consulting in Durham, N.C. Despite the six-month reprieve, HHAs “should begin working on them now,” Adams recommends.

That process should start with a thorough reading of the CoPs final rule in the April 3 Federal Register.

2. Examine your current forms and operations. “Agencies need to compare their current Patient Rights policies, forms, and processes against the conditions and identify what needs to be added,” Adams advises. Don’t forget to “look at  ther tools, like admission booklets, that could be impacted by these changes,” she adds.

3. Minimize the impact. Agencies will find that “many of the requirements in the Patient Rights section are either already required, being covered, or could easily be covered with some tweaking of current forms,” believes consultant Karen Vance with BKD in Springfield, Mo.

For example: “Most agencies are currently using a form for ‘service agreement,’ or ‘assignment of benefits,’ which should include the anticipated services (notifying the beneficiary in advance), etc.,” Vance tells Eli. “This could be tweaked to include legal representative language.”

This form, which agencies already have the patient sign, also usually contains language about Patient Rights, the privacy notice, etc., Vance notes. Many HHAs can just add language about receiving the transfer and discharge policy information as well to cover that base.

The same goes for Home Health Change of Care Notices and Notices of Medicare Non Coverage. These forms that HHAs currently use can be adapted for the new Patient Rights requirements, notes legal nurse consultant Carolyn Williams with law firm Brooks Acevedo in Houston.

4. Map out your compliance strategy. Once you’ve identified the way your forms and processes do not cover the new Patient Rights requirements, determine how to change them so that they do, Adams instructs. Assign a person or persons to be in charge of the effort.

Tip: Make sure you match up the patients with the correct federal and state agencies for the area in which they reside, advises Sharon Litwin with 5 Star Consultants in Camdenton, Mo. In other words, you’ll have to have a set of numbers for at least the five agencies CMS identifies for every area your agency covers — and make sure the correct area forms are given out to the correct patients.

CMS offers websites for contact information for those five agencies on p. 4525 of the CoPs final rule at www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf.

5. Double-check against the Interpretive Guidelines. HHAs shouldn’t wait for CMS to issue the Interpretive Guidelines for the new CoPs to start their CoP compliance strategy, advises attorney Robert Markette, Jr. with Hall Render in Indianapolis. There simply isn’t enough time, and the Guidelines will clarify some details but not change the overall requirements.

However, once the Guidelines come out, you should check your forms and policies to make sure they comply and make any necessary tweaks, experts offer.

Industry veterans had expected the Guidelines to come out in June before the nowbumped July deadline for implementation. That date may slide now that implementation is pushed back to January.

6. Train staff. Once you’ve got your new forms, policies, and procedures ironed out, it will be time to take on one of the biggest obstacles of the new CoPs — employee education. “The process and resultant outcome of training the clinicians to understand and adequately and comprehensively convey the Patient Rights information will be a compliance challenge for agencies,” predicts consultant Anna Doyle with Laff Associates in Hilton Head Island, S.C. “This is related to the inherent difficulty in imparting this important information at the beginning of care (when the patient and caregiver are most likely to be overwhelmed) and the need for the patient and caregiver to truly understand Patient Rights when they sign them.”

CoP compliance is going to rely heavily on frontline staff being able to make real-time decisions on items such as which type of representative a family member is and what notices they need as a result.

7. Consider a jump start. For some areas, HHAs can go ahead and start implementing changes so they can assure full compliance on the Jan. 13 start date, notes Lisa Selman-Holman with Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. The Patient Rights changes generally fall into that category.

Watch out: But don’t start complying with new CoP requirements before the implementation date, if it means you’ll fall out of compliance with the current CoPs, Selman-Holman warns. Surveyors will hold you to the CoPs that are in effect at the time of the survey.

8. Look at the big picture. When you are crafting your new policies, procedures and forms, think about the intent of the new CoPs, advises Washington, D.C.-area healthcare attorney Elizabeth Hogue. “The biggest challenge may be to go beyond specific requirements to an on-going collaborative process with patients, their families, and caregivers,” Hogue says. “The requirements related to patients’ rights undergird and support a goal of engagement of patients in their care which may produce a higher quality of care and better outcomes.”

“The basis of the revised CoPs is to limit the direction on structure and process — what format and how to relay information — and allow the agency flexibility in how to package that information,” Adams notes.

Bottom line: “The agency must be able to demonstrate to a surveyor how they gave this information,” Adams says.