Home Health & Hospice Week

CMS confirms six-month Conditions of Participation delay in final rule.

Ramping up to comply with the new home health Conditions of Participation is tough enough, but doing it without the Interpretive Guidelines for surveyors is a serious concern for home health agencies.

In a final rule published in the July 10 Federal Register, the Centers for Medicare & Medicaid Services confirms the six-month delay it proposed in March for CoP implementation (see Eli’s HCW, Vol. XXVI, No. 14). That puts the new CoP deadline at Jan. 13, 2018.

In response to questions from the proposed rule comments, CMS also reveals a timeline for issuing its Interpretive Guidelines based on the new reg. “We expect to release a preliminary draft of the revised guidelines to HHA stakeholders for informal input in the fall of 2017,” CMS says in the rule. “Comments from stakeholders will be taken into consideration as the draft is finalized. We intend to publish a final version of the Interpretive Guidelines in December 2017.”

The six-month delay to the CoPs is good news, experts agree. “I was pleased to hear of the delay to the CoPs,” notes consultant Pam Warmack with Clinic Connections in Ruston, Louisiana.

The delay is “a significant win” for the home care industry, says the National Association for Home Care & Hospice.

“Any additional time, if utilized by the industry, is helpful,” says attorney Robert Markette Jr. with Hall Render in Indianapolis. “There is a lot of work to do before January and every extra day helps.”

Pushing Guidelines Perpetuates Original Problem

However, “the fact that the interpretive guidelines may not be finalized until December 2017 undercuts a lot of the benefit of the delay,” Markette tells Eli. “The guidelines are important for surveyor training and for agencies to understand how CMS is going to interpret these new requirements. Without them, there is some concern that our compliance efforts may not hit the mark.”

Judy Adams with Adams Home Care Consulting in Durham, North Carolina, “was really hoping that the Interpretive Guidelines would be out sooner,” she says. “That is where the questions have been.”

“A major problem I had with the original implementation date of July 2017 was that there were no Interpretive Guidelines,” Warmack says. “Often it is difficult to determine the intent of a regulation in the Federal Register and the Interpretive Guidelines are much more helpful in that regard.”

Now the problem of a CoP deadline without much advance time for Interpretive Guidelines has just been postponed instead of resolved.

“The sooner the CMS issues the Interpretative Guidelines the better,” NAHC says in its member newsletter. The expected issuance date of December “is not nearly enough” time for agencies to prepare, the trade group says.

CMS should also provide training to HHAs on the new CoPs, NAHC contends. CMS should “provide the same training to the home health community that it provides to the state surveyors,” the trade group argues. “If all stakeholders receive the same information, it will go a long way to ensure that CMS’ expectations for compliance are met.”

In fact, CMS should really have pushed the CoP deadline later considering its expected release of the guidelines, argues Sharon Litwin with 5 Star Consultants in Camdenton, Missouri. Giving agencies another six months after the interpretive guidelines are out would make the most sense.

But in the delay final rule, CMS dismisses the guidelines’ importance. “Even absent a final version of the Interpretive Guidelines published in the SOM, surveyors will still be able to survey HHAs to assess compliance with the regulations,” CMS insists. “A delay in the release of Interpretive Guidelines would not require a further delay of the effective date for the new HHA CoPs.”

The CoPs contain major changes and complex requirements. Even with the additional six months, HHAs should already have been working full speed on readiness for the new regulation.

HHAs “should not have slowed down their efforts based upon the delay,” Markette says.

But agencies that have been working diligently on CoP readiness may find that they are stuck waiting for the guidelines now before they can do anything else, Adams says. They “need the Interpretive Guidelines for further clarification on how surveyors will look at these requirements.”

“It is time for CMS to quit stalling and provide all the appropriate information,” Adams continues. “Delays and uncertainty make it hard for agencies to prioritize among competing needs and move forward on changes such as these.”

Note: See the delay final rule at www.gpo.gov/fdsys/pkg/FR-2017-07-10/pdf/2017-14347.pdf.