Home Health & Hospice Week

Time is of the essence.

A regulation change 20 years in the making is final at long last, and it will mean a mad dash to the compliance finish line for home health agencies.

The Centers for Medicare & Medicaid Services has released the final rule for the Conditions of Participation for Home Health Agencies. CMS proposed the CoPs in 2014 (see Eli’s HCW, Vol. XXIII, No. 35), although that’s only the latest chapter in the COP saga. CMS actually proposed changes to the Home Health CoPs back in 1997, but the changes were never finalized amid the drastically revamped reimbursement and regulatory landscape.

“Nearly 20 years is a very long time from the first draft to the final regulations that govern the provision of home health services,” observes industry veteran Judy Adams with Adams Home Care Consulting in Durham, N.C.

With its Jan. 9 release of the CoP final rule, CMS has added new CoPs, drastically revised some other CoPs, and made a variety of other small and large changes (see box, p. 20, for partial list).

Of concern for many agencies: CMS is giving providers little time to catch up with the new requirements. “These regulations are effective on July 13, 2017,” CMS says in the rule scheduled for publication in the Jan. 13 Federal Register.

“We had asked for 12 to 18 months” for lead time, William Dombi, VP for law with the National Association for Home Care & Hospice, tells Eli. Instead, agencies will get six months.

“Six months is nothing for this major change,” protests Sharon Litwin with 5 Star Consultants in Ballwin, Mo. “We waited so long for them and now they give us six months,” Litwin exclaims.

In the rule, CMS acknowledges that of the 199 comment letters the agency received on the proposed rule, “the vast majority … made suggestions related to the effective date of the final rule. Commenters strongly expressed a need for a significant period of time to prepare for implementation of the new rules, noting that HHAs would need to adjust resource allocation, staffing, and potentially even infrastructure. Recommended implementation time frames ranged from 6 months to 5 years. The most frequent suggestion was to implement the final rule 1 year following its publication.”

Yes, CMS agrees “that it is appropriate to allow additional time to implement the final rule in order to allow HHAs adequate time to prepare for these changes,” according to the rule. But “we believe that requiring HHAs to comply with the requirements of this rule on July 13, 2017 is sufficient to allow for appropriate HHA preparations to implement these changes,” CMS contends.

Patients, Outcomes Take Center Stage

The new CoPs reflect CMS’s shift in focus from processes to outcomes and patients. The regs “will improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights,” CMS says in a release. The rule aims “to improve the quality of care furnished through the Medicare and Medicaid programs, while streamlining requirements for providers.”

The CoP rule “focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services; and builds a foundation for ongoing, data-driven, agency-wide quality improvement,” CMS adds in a message about the regulation.

Overview: “The new CoPs are based on patient-centered goals and resultant outcomes that involve smooth and comprehensive transitions in care and an interdisciplinary approach to the overall patient assessment, care planning, education, service provision and consistent analysis of quality and performance improvement,” says Anna Doyle, consultant with Laff Associates in Hilton Head, S.C. “The emphasis is on the involvement of the patient in planning their care and expected outcomes as well as providing a voice for patient rights and patient safety, appropriate education and communication necessary amongst disciplines, caregivers and other providers to increase transparency and improve care delivery in transition from acute to post-acute health care settings.”

The rule shows a “change in focus from structure and process to patient centered services with the focus on outcomes,” Adams believes. The rule “supports the increased role of home health as a primary player in case management and positive transitions across the continuum of health care.”

Note: The final rule is at https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-00283.pdf.