Home Health & Hospice Week

CMS issues 48 FAQs on HH Conditions of Participation.

The drastically revamped Home Health Conditions of Participation have been in effect for more than a year now, but home health agencies continue to wonder about many aspects of the new and updated regulations. Now, Medicare has offered insight on some gray areas.

In a Jan. 23 letter to State Survey Agency Directors, the Centers for Medicare & Medicaid Services lays out 48 frequently asked questions and answers about compliance with the CoPs. CMS will post the 11-page letter to the CMS home health center webpage soon, says HHH Medicare Administrator CGS in a message to providers.

The FAQs are “actually helpful,” says attorney Robert Markette Jr. with BKD in Indianapolis. “It reinforced a few key points.”

“Even though the final version of the interpretive guidelines for these CoPs was finalized at the end of August 2018, there were still outstanding questions,” notes the National Association for Home Care & Hospice in its newsletter. “Many have been answered in the FAQs,” the trade group praises.

The guidance offered in the FAQs is effective immediately, CMS says in the letter.

The FAQs offer welcome clarifications in areas ranging from verbal orders to interpreter services to administrator duties. But the questions also contain some answers that home health agencies may not be as happy to see.

For example: CMS emphasizes in two different questions that aide competency testing must take place on patients, not volunteers or pseudo patients. “The CoPs require that certain aspects of the competency testing be completed on a patient of the HHA. See §484.80(b) & (c)(1) to determine which aspects of the testing must be completed on a patient. When testing is indicated on a patient, a volunteer or pseudo-patient is not permitted,” CMS says in one FAQ.

“The requirement is for the competency testing to be completed on an actual patient of the HHA. See §484.80(c)(1),” CMS reiterates in another FAQ.

The competency requirement includes these two troublesome tasks: Giving the patient a “Sponge, tub, and shower bath” and “hair shampooing in sink, tub, and bed” (emphasis added). The former CoPs said “or” instead of “and.”

CMS’s unwillingness to back off of this requirement is unfortunate, because it “is creating a lot of problems for a lot of agencies,” Markette tells Eli. (For more on those difficulties, see Eli’s HCW, Vol. XXVII, No. 33.)

NAHC’s Mary Carr wasn’t surprised to see CMS stand firm on the pseudo-patient point in the FAQs. “When we saw in the IGs issued in August that CMS did not include pseudo patient, we knew they were maintaining this position,” Carr tells Eli.

The tub bathing and shampooing requirements are “very burdensome for agencies and beneficiaries,” Carr continues. “Many HHAs have few, if any, patients that can take tub baths, and those that can often refuse. So the pool of candidates is small.”

For example: “One large provider I spoke with said they often have to go to another one of their agencies that might be in a different service area just to find a patient that is willing to take a bath or shower,” Carr relates. “Patients become inconvenienced and stressed when asked if they can be bathed in a manner they are not used to.”

Carr suspects agencies have had to get creative in finding patients. “I am sure it was costly,” she says.

NAHC is collecting data via a survey to further lobby CMS to change this requirement, the trade group says.

Hope You Like Your Current Job

Another FAQ will put administrators who lack a college degree in a tough spot.

Question: A HHA administrator with 16 years of experience plans to change jobs but does not meet the new education requirement of having an undergraduate degree. Will CMS grant a temporary waiver to this requirement for individuals in this situation?

Answer: “There is no waiver for this requirement,” CMS says. “Administrators that begin employment with an HHA on or after January 13, 2018 must be a licensed physician, a registered nurse, or hold an undergraduate degree. See §484.115(a).”

Note: The FAQs are at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/AdminInfo19-07-HHA.pdf.