CMS Announces Final Rule That Outlines Home Health Conditions of Participation

Posted on Wednesday, January 11, 2017 7:11 PM

The Centers for Medicare & Medicaid Services (CMS) rolled out its final rule outlining the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies.

The rule was highly anticipated after a draft proposal was presented in 2014. The rule was required to be finalized within a three-year period and will be published on the Federal Register on January 13, 2017.

“Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies,” Kate Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, said in a press release. “Today’s announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholder and medical evidence.”

Many industry groups, including the Visiting Nurse Associations of America (VNAA) and the National Association for Home Care & Hospice (NAHC), were supportive of the initiatives introduced in the 2014 draft proposal.

“We do agree with many of the main principles the CoP, the conditions, were trying to get at, which was patient-centered care,” Joy Cameron, vice president of public policy at the Visiting Nurse Association of America (VNAA), said during a policy update call with members Monday. “It will be interesting to see the difference between the draft and now, because a significant amount of time has passed.”

The finalized rule includes several updates to the CoPs. The following updates were summarized by CMS in its announcement of the rule:
• A requirement for an integrated communication system that ensures patient needs are met, care is coordinated and that there is active communication between a home health agency and the patient’s physicians
• A requirement for data-driven, agency-wide quality assessment and performance improvement (QAPI) program that evaluates and improves agency care for patients at all times
• An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring plans of care meet patients’ needs

To finish off the proposal period, industry groups voiced their concerns and what actions home health agencies must take.

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