Home Health & Hospice Week

Watch out for transition period mistakes.

The implementation date for the new and revised Home Health Conditions of Participation may be delayed, but your preparation efforts should not be.

On March 31, the Centers for Medicare & Medicaid Services proposed a six-month push to the HH CoPs’ implementation date — from July 13 to Jan. 13, 2018. “Following publication of the January 2017 HHA CoPs final rule, we received inquiries that represented a large number of HHAs requesting that the agency delay the effective date for the new HHA CoPs. The inquiries asserted that HHAs were not able to effectively implement the new CoPs until CMS issued its revised Interpretive Guidelines (State Operations Manual, CMS Pub. 100–07, Appendix B),” CMS says in the proposed rule published in the April 3 Federal Register.

Other good reasons CMS heard for delaying the CoPs were “HHAs were unable to effectively implement the new CoPs until CMS issued further sub-regulatory guidance related to converting subunits to branches or independent HHAs, which would impact 216 HHAs nationwide” and an “estimated $300 million cost to implement the new requirements,” according to the rule.

“We believe that the concerns expressed in the inquiries have merit, so in response … we propose to delay the effective date of the January 2017 HHA CoPs final rule for an additional 6 months,” CMS says in the rule.

The delay is “good news,” cheers consultant Pam Warmack with Clinic Connections in Ruston, La. HHAs have been working frantically on compliance and wondering how they were going to pull it off. “I have been working with my clients since the CoPs were originally posted and it has been hectic to say the least,” Warmack tells Eli.

Don’t Wait On Interpretive Guidelines

A major impediment to compliance prep for the new CoPs has been the lack of interpretive guidelines for them, experts note. Now HHAs should have more time with the guidelines before implementation.

But HHAs shouldn’t let off the gas for CoP prep due to this delay, urges attorney Robert Markette Jr. with Hall Render in Indianapolis. To the contrary, it’s time to put the pedal to the metal.

“There is a tremendous amount of work to be done by providers to get prepared for these changes,” Warmack cautions.

“They should begin working on them now,” if they haven’t already, says Judy Adams with Adams Home Care Consulting in Durham, N.C.

The task list providers have ahead of them to comply with the new CoPs is daunting, experts warn. “The new CoPs will require that agencies educate staff, make adjustments to policies and educate staff on the policies, revise forms, and revise internal processes,” says Carolyn Williams, legal nurse consultant with law firm Brooks Acevedo in Houston.

“Agencies must surely get to work now on compliance with the new CoPs,” Washington, D.C.- based healthcare attorney Elizabeth Hogue says. “Time’s awastin’! It’s a big wad of changes to swallow and the sooner agencies start chewing, the more likely that they will be successful,” Hogue tells Eli.

Agencies should already have been working on CoP compliance before the delay proposal, notes consultant Anna Doyle with Laff Associates in Hilton Head Island, S.C. The proposed rule was out back in 2014 and CMS issued the final rule in January (see Eli’s HCW, Vol. XXVI, No. 3).

And agencies with third-party accreditation may already be complying with some of the new CoP requirements, Adams adds.

But there is still an extreme amount of work to get through before compliance can be assured, Markette notes. If providers let up on CoP prep, they’ll find themselves back in the position of scrambling to meet the rule with too little time six months down the road, he warns.

“We begged for this extra six months,” Markette notes. “Use it,” he urges.

Do this: HHAs should have already formulated a six-month plan to adhere to the new CoPs after CMS issued the January rule. Now providers can take the portion of the plan they haven’t yet completed and expand it into the new timeframe, Markette advises.

While the pace of work will still be intense, it won’t be quite as frantic — or its completion as impossible — as with the original July 13 deadline. Having the CoP guidelines will be “a blessing” when it comes to CoP prep, Warmack says.

But don’t just stop your CoP to-do list until those guidelines come out, Markette cautions. Experts had expected the guidelines to come out by June, before the previously set July deadline. Now the guideline release date may get pushed back farther.

“What we hear [is] that it is in the works,” says William Dombi, VP for Law with the National Association for Home Care & Hospice. “That is about as specific as CMS will get.”

Clue: “We asked that the delay account for the guidance by making the new rules effective at least six months after the guidance is issued,” Dombi tells Eli. But CMS certainly isn’t required to comply with that request.

The guidelines will clarify details, but won’t change any of the major requirements in the new and revised CoPs, Markette stresses. The smart move is to construct your new policies, procedures and processes, then make tweaks accordingly when the guidelines come out.

“Waiting for the interpretive guidelines just doesn’t make a lot of sense,” Markette says.

Note: See the CoPs proposed delay at www.gpo.gov/fdsys/pkg/FR-2017-04-03/pdf/2017-06540.pdf. The CoPs final rule is at www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf.