Home Health & Hospice Week

Other guidance is not as well received.

The draft Interpretive Guidelines for the impending Home Health Conditions of Participation may not be all home health agencies hoped for, but it does include one bright point.

The National Association for Home Care & Hospice applauds the clarification under the IG for §484.60(c)(1), where the Centers for Medicare & Medicaid Services says "The signature and date of the review by the responsible physician verifies the interval between health care plan reviews" and "Interim changes in physician orders and the plan of care do not automatically restart the timeframe for physician review of the plan of care." That language indicates that CMS won't require the home health POC be submitted to the physician every time a verbal order is received, notes NAHC's Mary Carr.

That clarification is helpful, because having to redo the POC for every verbal order would have been "unworkable," judges attorney Robert Markette Jr. with Hall Render in Indianapolis.

Another good point of the clarifications is highlighting the overall COP theme of collaboration between all professionals providing care, says consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. "Only through a collaborative effort can the most positive patient outcome be achieved," Warmack points out. "Often, mistakes or missed opportunities to improve a patient's status occur because professionals don't communicate and share information and insight."

Also welcome is the CMS explanation that in §484.115(a), which spells out an HHA administrator's qualification requirements, the "undergraduate degree" required can be an associate's degree as well as a bachelor's degree.

Along with the good also comes some bad, however.

The IG for 484.55(a)(1), which says "If an HHA is unable to complete the initial assessment within the 48 hours it is not acceptable to request a different start of care date from the physician to ensure compliance with the regulation or to accommodate the convenience of the agency," worries Warmack. "I fear this will be very problematic," she tells Eli.

Another guideline that Warmack finds concerning is also in 484.60(c) about reviewing and revising the POC. The guidance reads, "If there is a significant change in the patient's condition and the services to be provided by the HHA, the revised plan of care is sent to the responsible physician for review and approval which restarts the 60 day period for review of subsequent plans of care," according to the draft.

"I don't like this one at all," Warmack emphasizes. "This changes the episodic payment dates and will throw off OASIS completions, etc."

Short Timeframes Spell Trouble

Also problematic is the reflection of the strict and short timeframes for activities outlined in the CoPs, Warmack notes. "Often we must notify patients or their representatives 'in advance' of care or 'by the next visit,'" she says. And "documents must be produced and provided within two days, four days, etc.," she adds.

Risk: "Those of us who work in home health know that there are often circumstances that make it impossible to meet very strict timelines," Warmack says. "But we will all do our very best."

Like many, Warmack notes that the draft IGs "didn't include any clear guidance" for many standards (see story, p. 303). Specifically, "I was ... anticipating guidance on the legal representative versus patient representative and timeframes for the agency to communicate with these individuals once they are discovered," she gives as an example.

Note: See the draft IGs at http://report.nahc.org/wp-content/uploads/2017/10/3819-FHomeHealthAgency-CoPs_IGs.pdf.