Proposed Rulemaking on Conditions of Participation for Home Health Agencies: Revision of Requirements

Overview: The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care to home health patients. The proposed regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes.

 Background

As part of HHS’s priority focus on health care quality, CMS has issued a proposed rule that improves the home health care provided by approximately 12,500 home health agencies nationwide to five million Medicare and Medicaid beneficiaries annually.

This proposed regulation responds to numerous changes in the home health industry:

• It focuses on assuring the protection and promotion of patient rights;
• Enhances the process for care planning, delivery, and coordination of services;
• Streamlines regulatory requirements; and
• Builds a foundation for ongoing, data-driven, agency-wide quality improvement.

This proposed rule represents the first update to the Home Health Agency Conditions of Participation since 1989. The regulation, as proposed, creates a framework for innovation and flexibility by adding requirements that are able to be adapted to the needs of individual home health agencies over an extended period of time. The proposal also addresses the use of current patient care and home health agency management practices, most notably by incorporating agency-identified patient measures into both the care planning and quality processes. 

Provisions of the Proposed Rule

The proposed rule:

• Includes revisions to the Outcomes and Assessment Information Set (OASIS) requirements to update applicable electronic data transmissions to meet current federal standards.
• Expands the current patient rights requirements to clarify the rights of each patient, the process for conducting patient rights violation investigations, and the process for addressing verified violations.
• Focuses the patient assessment requirement on each patient’s physical, mental, emotional, and psychosocial condition.
• Adds a requirement that a home health agency (HHA) must maintain a system of communication and integration to identify patient needs, coordinate care provided by all disciplines, and effectively communicate with physicians. This requirement would formalize and shape current, informal communication and coordination structures within HHAs to assure that patients receive the right care from the right discipline at the right time, with the ultimate goal of improving patient care outcomes and efficiency.
• Incorporates a new requirement for each HHA to develop, implement, and maintain an agency-wide, data-driven quality assessment and performance improvement (QAPI) program. The QAPI requirement mirrors activity already taking place in the HHA industry’s move towards a prospective quality of care approach that focuses on preemptive planning that continuously addresses quality improvement. It would be based on data already collected in the OASIS process, CMS-provided patient outcome and process reports, and numerous other industry efforts currently underway.
• Addresses a new infection control requirement that reflects current health care practices. It would require each HHA to maintain and document a program to prevent and control infections and communicable diseases. The infection control program would follow accepted standards of practice, including standard precautions, and educate staff, patients, and caregivers about proper infection control procedures.
• Condenses the requirements for nursing and therapy services into a single requirement that focuses on integrated patient care planning and delivery, and assures appropriate supervision of all services.
• Reinforces the current home health aide supervision requirements by requiring additional supervision and training when an agency suspects that home health aide skills are insufficient.
• Clarifies the management and administrative structure of HHAs by allowing the administrator to designate an individual to act in his/her absence, which may be the skilled professional that is available during all operating hours.
• Continues to allow home health agencies to have branch offices, but eliminates “subunits.” Designating an HHA location as a “subunit” is a vestige of the old HHA payment system. Under the current payment system, having HHA “subunits” is no longer necessary. This change allows parent agencies to have greater control over all of their offices by placing all locations under the leadership and direct management control of the parent agency. The process for requesting the addition of a branch office would remain unchanged.

For more information, visit: http://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html.

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