Home Health & Hospice

CMS proposes long-anticipated revisions to HH CoPs

Homecare Insider, October 13, 2014

CMS has issued a proposed rule to significantly update the Conditions of Participation (CoPs) for the home health industry for the first time since their inception in 1989. The new provisions promote patient-centered, interdisciplinary care to foster CMS’ aim to “achieve broad-based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers' care.”
The long-awaited proposal has been met with excitement from the industry. Although CMS has made several significant revisions to the HH CoPs over the years, many of the current CoPs have remained unchanged since their implementation 25 years ago. In 1997, CMS attempted to revise the CoPs with a proposed rule that focused on patient-centered quality standards, but because the agency failed to publish a final rule within the required three-year time frame, the proposal was rescinded.
To develop the new batch of proposed CoPs, CMS considered recommendations from a variety of industry stakeholders, including providers, professional associations and practitioner communities, consumer advocates, and governmental agencies, as well as comments submitted by the public on the 1997 proposed rule and suggestions submitted by the home health industry in 2011.
Using this input, CMS adopted the following principles to overhaul the longstanding CoPs:
  • Develop a more continuous, integrated care process across all aspects of home health services, based on a patient-centered assessment, care planning, service delivery, and quality assessment and performance improvement
  • Use a patient-centered, interdisciplinary approach that recognizes the contributions of various skilled professionals and their interactions with each other to meet the patient’s needs; stress quality improvements by incorporating an outcome-oriented, data-driven quality assessment and performance improvement program specific to each home health agency
  • Eliminate the focus on administrative process requirements that lack adequate consensus or evidence that they are predictive of either achieving clinically relevant outcomes or preventing harmful outcomes for patients
  • Safeguard patient rights
The most significant proposed changes take the form of four new or revised CoPs:
  • The CoP for “Patient rights” would emphasize an agency's responsibility to respect and promote the rights of each patient. The revision would expand the current patient right CoP at §484.10 by requiring an agency to inform patients of their rights both in writing and verbally, comply with limited English proficiency requirements, and increase patients’ rights through care planning practices.
  • The CoP for “Care planning, coordination of services, and quality of care” would promote an interdisciplinary team approach to facilitate the development of better processes dedicated to care planning, coordination of services, and quality of care. This provision would combine the current CoP at § 484.18, entitled “Acceptance of patients, plan of care, and medical supervision,” with the standard at §484.14(g), “Coordination of patient services,” and revise the contents of both.
  • The CoP for “Quality assessment and performance improvement” (QAPI) would hold every agency responsible for conducting an ongoing quality assessment that incorporates data-driven goals and an evidence-based performance improvement program to kindle improvement in the quality of care delivery.
  • The CoP for “Infection prevention and control” would require agencies to follow accepted standards of practice to prevent and control the transmission of infectious diseases and to educate staff, patients, and other caregivers on these best practices.
Comments are due to CMS no later than 5 p.m. on December 8.
Read the full proposal here.