Home Health & Hospice Week

QAPI will make some unfamiliar demands.

As you go about implementing the many new requirements in the Home Health Conditions of Participation that take effect in July, put governing body changes near the top of the priority list.

The CoPs rule “increases the involvement, responsibility and accountability of the HHA’s governing body,” noted law firm McDermott Will & Emery when it was proposed. (See box, p. 43, for final CoPs related to the governing body.)

Perhaps the biggest change will be the governing body’s role in the new Quality Assessment and Performance Improvement CoP. The Centers for Medicare & Medicaid Services specifies in the rule that the HHA’s governing body must “assume responsibility for the agency’s QAPI program.” Duties range from making sure the QAPI plan addresses emergent services to approving the data collection specifics (see box, p. 43).

Plus: “It is the governing body which would be ultimately responsible for establishing the HHA’s expectations for patient safety through an agencywide QAPI program,” CMS adds. “Therefore, we proposed that the governing body establish clear expectations for patient safety. We also proposed that the governing body would appropriately address any findings of fraud or waste in order to assure that resources are appropriately used for patient care activities and that patients are receiving the right care to meet their needs.”

Home health agencies have their doubts about the body’s prominent role in QAPI. Commenters on the CoPs proposed rule released in 2014 told CMS “that the approval of data collection should be the role of the HHA leaders, not the governing body,” the final rule notes.

But being responsible for something doesn’t mean the body has to handle all the details. “The HHA governing body is responsible for approving data collection, leaving HHA management responsible for all of the research and decisions leading up to final approval by the governing body,” CMS says in the final rule.

Under the new CoPs, “the governing body will have an important role in the QAPI process,” stresses attorney Robert Markette Jr. with Hall Render in Indianapolis. And you have only a short time to get them up to speed.

The QAPI requirement isn’t a total departure from the current CoPs. “The governing body was involved in the old HHA evaluation efforts,”

Hall Render notes in online analysis. But “this standard will require more understanding and involvement from the governing body.”

Note: The CoPs final rule is at www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf.