Home Health & Hospice Week

CMS acknowledges reality in one area.

Medicare will loosen up its testing requirements when aides are found wanting, if a new proposal is finalized as-is.

Section 484.80(h)(3) HH CoPs requires that, “when a supervisory visit identifies a deficiency in a home health aide’s skills, the HHA must conduct, and the aide must complete, a full competency evaluation to assess all aide skills and identify any other skill deficiencies that were not identified while observing the aide performing care with a patient.”

Commenters convinced the Centers for Medicare & Medicaid Services that “a full competency evaluation is unnecessary and overly burdensome when only certain skills have been identified as deficient,” according to the rule published in the Sept. 20 Federal Register. “We propose to eliminate the requirement to conduct a full competency evaluation, and replace it with a requirement to retrain the aide regarding the identified deficient skill(s) and require the aide to complete a competency evaluation related only to those skills. This targeted retraining and competency evaluation requirement would reduce the time spent completing competency evaluations and retraining efforts.”

In other words, if the aide demonstrates a deficiency in transferring a patient safely, why test her on bathing?

This proposed change “makes complete sense,” cheers attorney Liz Pearson with Pearson & Bernard in Edgewood, Kentucky. “If an aide is deficient in a single or more task, there should be retraining and competency evaluation on those deficient practices.” This change will be a “time saver and much more ... realistic,” Pearson says.

However, it doesn’t really help HHAs all that much because finding an aide deficiency is relatively rare. The regulatory relief would be “small to moderate” because “the percentage of aides found deficient in one or more skills is very small,” reports consultant Kathy Roby with Qualidigm based in Wethersfield, Connecticut. Thus, “the relief obtained from correcting that skill only, while greatly appreciated — and significantly more logical — is limited,” Roby tells Eli.

Alternate viewpoint: Consultant Julianne Haydel with Haydel Consulting Services in Baton Rouge, Louisiana, would like to see CMS retain the current requirement. We, as an industry, are sorely deficient in training,” Haydel argues. “It shouldn’t take but an extra 30 minutes to do a full competency. Home health aides are worth the time.”

Where Is Pseudo-Patient Change?

Meanwhile, HHAs might be disappointed that CMS includes this aide change, rather than one they really want to see.

CMS does not address the most critical aide-related issue for burden relief in this rule — the requirement for initial competency testing to be done on live active patients rather than permitting laboratory or peer demonstration, Roby insists. This new CoP requirement “has significantly increased regulatory burden and cost for providers,” Roby notes (see Eli’s HCW, Vol. XXVII, No. 16).

This new burden has been protested by the industry and its representatives “for months and been ignored,” Roby says.