Select Conditions of Participation Revisions
Published on Thu Jan 12, 2017
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Revised §484.50(a)(1) to clarify that it is the patient’s legal representative that must be informed of the patient rights information prior to the start of care.
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Revised §484.50(a)(1)(i) to require that an HHA must provide each patient with written notice regarding the HHA’s transfer and discharge policies.
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Redesignated proposed §484.50(a)(2) as §484.50(a)(1)(ii) and removed the requirement that HHA administrators are expected to receive patient questions.
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Redesignated proposed §484.50(a)(4) as §484.50(a)(2), and clarified that a signature confirming receipt of the notice of patient rights is only required from a patient or a patient’s legal representative.
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Revised §484.50(a)(3), requiring that the HHA must provide verbal notice of the patient’s rights no later than the completion of the second visit from a skilled professional.
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Added new §484.50(a)(4), requiring that the HHA provide written notice of the patient’s rights and the HHA’s discharge and transfer policies to a patient-selected representative within 4 business days after the initial evaluation visit.
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Revised 484.50(b) to replace the term “incompetence” wherever it appears with the more precise term “lack legal capacity to make health care decisions.”
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Revised §484.50(c)(4)(i) to clarify that patients have the right to participate in and be informed about all assessments, rather than just the comprehensive assessment.
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Removed the requirement at §484.50(c)(4)(iii) regarding providing a copy of the plan of care to each patient.
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Revised §484.50(d) to remove the requirement for HHAs to provide patients with information regarding HHA admission policies and clarified that the “transfer and discharge policies” are those set forth in paragraphs (1) through (7) of this standard.
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Revised §484.50(d)(1) to clarify that HHAs are responsible for making arrangements for a safe and appropriate transfer.
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Revised §484.50(d)(3) to clarify that discharge is appropriate when the physician and the HHA both agree that the patient has achieved the measurable outcomes and goals established in the individualized plan of care.
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Revised §484.50(e)(1)(i) to clarify that the subject matter about which patients may make complaints is not limited to those subjects specified in the regulation. HHAs must investigate all such complaints.
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Revised §484.50(e)(1)(iii) to specify that HHAs must take action to prevent retaliation while a patient complaint is being investigated.
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Added a requirement at §484.55(c)(6)(i) and (ii) that the comprehensive assessment must include information about caregiver willingness and ability to provide care, and availability and schedules.
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Added a requirement at §484.60 that patient and caregiver receive education and training including written instructions outlining medication schedule/instructions, visit schedule and any other pertinent instruction related to the patient’s care and treatments that the HHA will provide, specific to the patient’s care needs.
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Revised §484.60(b)(1) to permit drugs, services and treatment to be ordered by any physician, not just the one responsible for the patient’s plan of care.
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Revised §484.60(b)(4) to permit any nurse acting in accordance with state licensure requirements to receive verbal orders from a physician.
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Added requirements at §484.60(d)(1) and (2) that HHAs must assure communication with all physicians involved in the plan of care, and integrate orders from all physicians involved in the plan of care to assure the coordination of all services and interventions provided to the patient.
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Revised §484.65 to require that QAPI program indicators include the use of emergent care services.
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Revised §484.80(b)(3)(xiii) by withdrawing part of the provision under home health aide training requirements for aides to recognize and report changes in pressure ulcers.
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Revised §484.80(g)(1) by removing the requirement that the skilled professional who is responsible for the supervision of a home health aide must be the individual who prepares written patient care instructions for the home health aide.
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Revised §484.80(h)(1)(i) by adding a requirement that the RN or other appropriate skilled professional who conducts supervision of a home health aide must be familiar with the patient, the patient’s plan of care, and the written patient care instructions described in §484.80(g).
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Redesignated §484.22 — Emergency Preparedness under subpart B as §484.102 under subpart C to align with CoP’s related to “Organizational Environment.”
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Added a requirement at §484.105(b)(1)(i) that the administrator must report to the governing body.
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Revised §484.105(b)(1)(iii) to require that the administrator assures that a clinical manager is available during all operating hours.
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Revised §484.105(b)(2) to clarify that an individual that is pre-designated to fill the administrator role in the absence of the administrator (including the clinical manager) must be qualified to do so.
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Revised §484.105(c) by retaining a description of the clinical manager’s duties while relocating the personnel specifications for this role to new §484.115(c), which sets for the specific personnel requirements for the clinical manager.
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Added a requirement at §484.110(a)(4) that the clinical record must include contact information for the patient’s primary caregiver(s).
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Revised §484.110(a)(6)(i) by changing the discharge summary deadline for completion from 7 calendar days to 5 business days.
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Revised §484.110(a)(6)(ii) by changing the transfer summary deadline for completion from 2 calendar days to 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility.
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Added §484.110(a)(6)(iii), requiring that a completed transfer summary must be sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer.
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Revised §484.110(e), requiring that 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).
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Revised the personnel qualification requirements for HHA administrators at §484.115(a) to grandfather in currently employed HHA administrators.
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Added §484.115(c) to specify personnel qualifications for clinical managers.
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Revised the proposal at §484.115(e) licensed practical nurse to utilize existing regulatory language regarding vocational nurses, and align the requirement with state practice acts.
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Made technical changes to the requirements at §484.115(f) through (i) to align with current personnel qualification requirements for occupational therapists, occupational therapy assistants, physical therapists, and physical therapy assistants.
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Moved proposed §484.60(a)(3) to §484.60(a)(2)(xii), making it applicable to all patients, and removed the terms “low,” “medium,” and “high.”
