CMS Might Delay the Implementation of CoPs for HHAs
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule on April 3rd that, if enacted, would push back the implementation date of the new home health Conditions of Participation (CoPs) to January 13th, 2018. That’s six months after the originally intended date of July 13th, 2017. The new CoPs – which are revisions of older requirements set forth by Section 1891 of the Social Security Act (SSA) – were officially published on January 13th, 2017 after several years of delay and review of public comments.
The Recent Proposal
The recent proposal to push back the date came as a response to certain comments put forth in October 2014. As stated in the proposed rule, “Commenters strongly expressed a need for a significant period of time to prepare for implementation of the new rules, noting that HHAs [or Home Health Agencies] would need to adjust resource allocation, staffing, and potentially even infrastructure.“
Besides pushing back the implementation date, CMS also aims to delay the phase-in date for the data driven performance improvement projects, which was originally intended to go into effect six months after the rule became active. Thus, if the enactment of the rule is pushed back to January 2018, the phase-in date would be delayed to July 13th, 2018.
Additionally, conforming to the proposed timeline, the rule would grandfather in all administrators who were hired by HHAs prior to July 13th, 2017, as opposed to January 2017. These administrators would not have to meet new personnel qualifications, which require an HHA administrator to be a licensed physician, be a registered nurse or hold an undergraduate degree, according to the January 17th revisions of the CoPs.
Once implemented, the CoPs will include necessary steps for ensuring the rights of patients who are under the care of HHAs and requirements for assessing the overall wellbeing of patients. Additionally, the rule will require patients and caregivers to have written information about future visits, treatments administered and medical instructions.
To improve overall quality, the rule will require HHAs to follow Quality Assessment and Performance Improvement (QAPI) standards, which mandate an ongoing data driven program aimed at the betterment of patient care. And to ensure oversight, patients and caregivers will have access to the contact information of an HHA clinical manager who will coordinate referrals and make sure that the plan for care meets the patient’s needs. The CoPs will also ensure an effective communication network between the various disciplines required for treatment as well as between the HHA and the patient’s physician.
Why the Hold Up
The original rule was proposed on October 9th, 2014 and now three years later, CMS has proposed an extension. According to William Dombi, vice president for law of the National Association for Home Care & Hospice (NAHC), this rule has been in the works for nearly 20 years, so it doesn’t make sense to force an effective date. And one of the major concerns, shared by the Visiting Nurse Associations of America, is that CMS has not yet released interpretive guidance to help enact the rules.
The concerns appear to be legitimate, but elderly and disabled patients under the care of HHAs via Medicare are probably less concerned about bureaucracy and more concerned with the potential quality of life improvements that could accompany the implementation of the revised CoPs.
Public comments will be accepted until 5pm on June 2nd, 2017.