Home Health & Hospice Week

There’s no time to waste.

If you don’t get up to speed on the newly finalized Home Health Conditions of Participation before their July deadline, you could see serious consequences.

Home health agencies “must meet the Medicare HH CoPs in order to participate in the Medicare program,” stresses the National Association for Home Care & Hospice. “Agencies that fail to meet any of the HH CoPs are at risk, at a minimum, for the imposition of a number of sanctions and potentially at risk for program termination,” NAHC warns in its member newsletter.

Remember: Surveyors now can use alternative sanctions for HHA survey infractions — payment suspensions and Civil Money Penalties since July 2014, and temporary management, directed plan of correction, and directed in-service training as of July 2013. Even if surveyors don’t outright terminate you for not complying with the new CoPs, they can invoke one of these punishments. And the harsher payment suspension and CMP sanctions can close your doors very quickly anyway, experts warn.

Don’t expect surveyors to give you a pass because the CoP standard with which you’re out of compliance is a new or heavily revised one, industry veterans warn. That means you need to master the new requirements by the time they are implemented July 13.

Heed this prep advice to comply with the new CoPs the Centers for Medicare & Medicaid Services published in the Jan. 13 Federal Register:

1. Get started immediately. You can’t afford to waste a minute when it comes to getting into CoP compliance. “It is a very quick implementation,” cautions Joy Cameron with the Visiting Nurse Associations of America. “The industry advocated for 18 months,” Cameron points out to Eli. But CMS rejected that timeline, which was frequently suggested in comment letters on the CoPs proposed rule, in favor of its six-month plan (see Eli’s HCW, Vol. XXVI, No. 3).

“HHAs need to start prepping today,” urges Sharon Litwin with 5 Star Consultants in Camdenton, Mo. The timeline is “crazy,” says Litwin, who “thought we’d have a year.”

The rule’s “biggest issue for agencies is that they have until July 13 to comply,” expects attorney Robert Markette Jr. with Hall Render in Indianapolis. “This will likely require a major effort,” he stresses.

2. Go to the source. Before you can formulate your compliance plan, you need to know what you’re complying with. “Begin prepping by reading through the final rule,” advises Judy Adams with Adams Home Care Consulting in Durham, N.C. The 88-page rule at www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf lists both the language for the 42 CFR revisions, and has a bullet list of changes between the proposed and final rules that summarize many of the revamps.

3. Target your hot spots. When reading the final rule, identify the areas you’ll need to work on to come into compliance, Adams counsels. Make sure the list is complete and you leave no areas neglected, or you could regret it come survey time.

4. Prioritize your CoP prep tasks. Once you’ve assembled your complete list of CoP items to address, it’s time to prioritize them, Adams says.

The order of priority will differ for different providers, Markette observes. Some items will simply require “reorganizing and tweaking” while others “will require substantive changes,” he notes.

Areas that will likely be at the top of the priority list for many agencies are the new patient rights and infection control CoPs, as well as the requirement to provide a discharge summary, predicts William Dombi, NAHC’s VP for law. And remember, the patient rights CoP requires new written and verbal notices, Dombi tells Eli.

Changes related to “the most important take-aways,” care transitions and interdisciplinary communication, should also rank high on the list, advises consultant Anna Doyle with Laff Associates in Hilton Head Island, S.C. That will mean “tightening process and policy,” Doyle says.

The new Quality Assurance Performance Improvement requirement is also likely to land at the top of providers’ to-do lists, Markette expects. Whether that’s a big or small item depends on the robustness of their current QAPI process.

5. Reach out to your vendors. Many of the CoPs relate to communication between care team members, and between the physician and the agency, Doyle points out. In its overview, CMS notes that the new CoPs aim to “use a patient-centered, interdisciplinary approach that recognizes the contributions of various skilled professionals and their interactions with each other to meet the patient’s needs.”

“Six of the twenty most frequently cited survey deficiencies center on the need for patient care coordination and implementation, including the most frequently cited deficiency related to ensuring that each patient has a written and updated plan of care,” CMS highlights in the final rule.

CMS tries to address that problem, in part, with communication-based changes. For example, under the Coordination of Care standard, the HHA must “assure communication with all physicians involved in the plan of care,” according to the final rule. The revised CoPs also require physician updates on the plan of care and other communications.

“Changes related to the use of technology in communication and the patient record also alter the communication amongst care providers — clinicians, physicians, etc. — which changes how people ‘talk’ to each other. At times, it is difficult to determine if what needed to be communicated has been and in a timely manner,” Doyle acknowledges. “This continues to be a challenge and a necessary focus for HHAs and associated vendors to more effectively share important information regarding patient care.”

And make no mistake, surveyors will hold you responsible for your vendor’s actions. “HHAs bear ultimate responsibility for continuous compliance with the requirements of these regulations, and are expected to manage all contracts, including those with software vendors, to assure such compliance,” CMS spells out in the final rule. “We urge HHAs to engage in due diligence to ensure that their vendors are providing them with EHR technology solutions that support patient health.”

6. Educate affected personnel. Both your staff and your referral sources will need to be aware of the new requirements in the CoPs, experts advise. Plan some hefty in-service training time, especially as the deadline draws near.

7. Watch for more guidance. The language of the final rule, which includes only the changed language and not the rest of the CoPs, might be confusing. Watch for forthcoming updates to the CFR. And CMS should issue updated surveyor interpretive guidelines, as well as education for HHAs, NAHC maintains.

Don’t be surprised if the interpretive guidelines aren’t ready soon. “Sometimes that seems to take forever,” notes Chicago-based regulatory consultant Rebecca Friedman Zuber.