For the first time in 25 years, CMS has proposed drastic revisions to its conditions of participation (CoPs) for home health agencies.
 
“We are proposing to revise the home health agency requirements to focus on a patient-centered, data-driven, outcome-oriented process that promotes high quality patient care at all times for all patients,” CMS states in the proposed rule released today. The proposal revises or eliminates many existing CoPs, focusing efforts on services delivered to patients, the quality of care agencies furnish and quality assessment and performance improvement efforts.
 
Under the proposal, CMS would establish four new CoPs pertaining to:
 
  • Patient rights. CMS seeks to clarify rights for each patient and revise the process for conducting patient rights violation investigations and addressing verified violations.
  • Care planning, coordination of services and quality of care. This would incorporate an interdisciplinary team approach, focusing on care planning, coordination of services and quality of care processes.
  • Quality assessment and performance improvement (QAPI). The QAPI incorporates “data-driven goals and an evidence-based performance improvement program of its own design to affect continuing improvement in the quality of care furnished to its patients.” The requirement mirrors activity already occurring within the industry, moving to “a prospective quality of care approach that focuses on preemptive planning that continuously addresses quality improvement,” a CMS release states. The requirement 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.”
  • ​Infection prevention and control. This requires agencies to follow accepted standards to prevent and control transmission of infectious diseases. It also tasks agencies with educating employees, patients and patients’ caregivers about these standards. Agencies must incorporate infection control components into the QAPI program.
 
Proposed rule removes CoPs, too
 
Among other things, CMS plans to remove the process requirement under §484.12(c) that agencies comply with accepted professional standards and principles. CMS plans to modify the requirement, referencing clinical practice guidelines and professional standards specific to home health.
 
“We are not proposing to incorporate by reference any specific clinical practice guidelines or professional standards of practice,” the proposal states. Agencies would be responsible for identifying their own performance problems through their QAPI programs, “addressing them and continuously striving to improve the quality of clinical care, patient outcomes and satisfaction, as well as efficiency and economy.”
 
CMS’ proposal also would remove requirements that agencies send summaries of care to attending physicians at least once every 60 days, that agencies have a group of professional personnel to advise its operation and that agencies conduct quarterly evaluation of its program via chart reviews.
 
Other proposed CoP changes
 
  • Revise OASIS requirements to update applicable electronic data transmissions to meet current federal standards.
  • Focus patient assessment requirements on each patient’s physical, mental, emotional and psychosocial condition.
  • Reinforce existing home health aide supervision requirements, requiring more supervision and training when agencies suspect aide skills aren’t sufficient.
  • Clarify agencies’ management structure, allowing administrators to designate an individual to act in the administrator’s absence
 
​CMS first published a proposed rule on March 10, 1997, that would have revised the entire set of home health CoPs. Due to the significant volume of public comments and the rapidly changing nature of the home health industry at that time, this rule in its entirety was never finalized, the rule states. 
 
Editor’s note: View the proposed rule at: http://www.ofr.gov/OFRUpload/OFRData/2014-23895_PI.pdf.
 
Comments will be due 60 days after the date that this proposed rule gets published in the Federal Register. Submit your comments to: http://www.regulations.gov.
 
Save the date: HHL will be hosting a webinar on this topic on Nov. 11. Details will be coming soon.