Home Health & Hospice Week

CMS sheds light on this sometimes confusing requirement.

Under the new CoPs, you'll have to furnish patients with their medical records for free - but the same isn't true for nonpatients.

The Centers for Medicare & Medicaid Services clarified this and other confusing points of the new record-furnishing requirement in the Home Health Conditions of Participation in its Jan. 24 Home Health Open Door Forum. Several home health agency representatives asked how the new requirement in the CoPs that took effect Jan. 13 works.

The revised requirement at § 484.110(e) under the Clinical Records CoP states "[a] patient's clinical record (whether hard copy or electronic form) must be made available to a patient, free of charge, upon request at the next home visit, or within 4 business days (whichever comes first)," according to the HH CoP final rule in the Jan. 13, 2017, Federal Register.

Providers asked these questions in the forum:

Question: Can agencies charge patients for factors such as photocopying or mailing?

Answer: The agency must furnish the record to patients free of charge, "period," a CMS official said in the forum.

HHAs can look to the rule and draft Interpretive Guidelines for more guidance. If a home visit comes before the four-day mark, agencies must comply with that timeline, CMS says in the CoPs final rule.

And "if a patient requests to have the plan of care emailed, the HHA would have a maximum of 4 business days to comply," the rule adds.

The requirement is §484.110(e) Standard: Retrieval of clinical records, CMS notes in the draft IGs.

Question: Does the requirement apply to active patients only, or all patients?

Answer: It applies to all patients, active or discharged, CMS clarified in the forum.

Question: Do agencies have to supply free records to others, such as insurance companies or attorneys?

Answer: HHAs must furnish records free of charge to patients and their representatives, as defined in the CoPs, CMS said. That includes their legal or patient-selected reps.

The draft IGs define a "representative" as "the patient's legal representative, such as a guardian, who makes health-care decisions on the patient's behalf, or a patient-selected representative who participates in making decisions related to the patient's care or well-being, including but not limited to, a family member or an advocate for the patient."

It is uncommon that an insurance company or an attorney would fit this definition of a representative, CMS acknowledged in the forum. When parties requesting records aren't patients nor reps as defined in the CoPs, agencies may charge for the records.