Home Health & Hospice Week

Some HHAs hoping for a Halloween treat feel tricked instead.

If you were thinking you might get some more breathing room on implementation of the significantly revamped Home Health Conditions of Participation, think again.

Why? The Centers for Medicare & Medicaid Services has informally released a draft of its CoP Interpretive Guidelines via an industry trade group, indicating it needs feedback on the document

before officially issuing it next month as scheduled. Implementation of the CoPs themselves remains on schedule for Jan. 13, 2018.

Shortcut: "CMS issued the IGs to the National Association for Home Care & Hospice ... with a request for stakeholder feedback," NAHC says in its member newsletter. "CMS is unable to entertain individual comments and requests that aggregated comments be submitted through NAHC." The trade group posted the draft IGs Oct. 27 and is requesting feedback by Nov. 10, so it can in turn relay aggregated comments to CMS by the agency's Nov. 15 deadline.

Home health agencies were hoping to get the IGs much sooner than the eve of CoP implementation, since the new Conditions were originally scheduled for a July start date and then delayed six months (see Eli's HCW, Vol. XXVI, No. 14). But if the final version of the IGs looks anything like the draft, providers aren't going to be happy with them in any case.

The draft IGs are "terrible," judges attorney Robert Markette Jr. with Hall Render in Indianapolis.

They are short, in comparison to the current CoP IGs, Markette notes. They simply don't address many of the standards altogether, and lack sufficient detail and clarification for others, he says.

Agencies tell Markette that the draft IGs provide such little guidance, that they are just waiting for CMS to release the final version next month in hopes that it's better, he relates.

Significant changes to the IGs are a possibility, says NAHC's Mary Carr. "The fact that they have reached out certainly suggests that they are open to suggestions," Carr tells Eli.

But Markette is not holding out hope for a drastic improvement in the guidance, he says.

Surveyor Training, Holiday Stress Add To CoP Crunch

Industry experts worry that the inadequacies of the CoP IGs will lead to survey citations for providers that are trying to comply, but don't know how.

Under the new alternative sanctions that home health surveyors can now wield, such noncompliance can quickly lead to agency closure, Markette worries. That's particularly a risk for Civil Money Penalties (CMPs).

It's not just HHAs that won't understand the new CoPs either. With the final IGs issued so close to the Jan. 13 implementation date, "will CMS have time to do training to all the State Survey teams?" asks consultant Pam Warmack with Clinic Connections in Ruston, Louisiana.

Surveyors with only a loose idea of some of the new CoPs' complexities and wielding CMPs can be very dangerous, Markette warns.

Warmack also worries that such a tight timeline will mean states will fail to rewrite their own standards, leaving agencies "stuck with having to demonstrate compliance to new CoPs and state regulations that maintain many of the old CoP-type regulations as well."

To make the compliance crunch even more severe, the final IGs and CoP implementation will come during the hectic holiday time period. "This is going to be a very expensive holiday season," Warmack exclaims.

Note: See a link to the 85-page draft IG PDF, as well as instructions for submitting comments, at https://report.nahc.org/cms-releases-draftversion-of-the-hhcop-interpretive-guidelines.