CMS issued a final rule, which was published in the Federal Register on January 13, 2017, intended to modernize the home health agency Conditions of Participation (CoPs).  The rule, which goes into effect on July 13, 2017, seeks to improve “the quality of health care services for all home health patients and strengthen patients’ rights,” according to CMS’s January 9, 2017 announcement of the final rule.

As previously reported, CMS has not successfully updated the home health CoPs since 1989.  On October 9, 2014, CMS issued the proposed version of the current rule. The final rule, which deviates minimally from the October 2014 proposed rule, the final rule establishes or modifies the following CoPs:

• Reporting OASIS information.  In this CoP, the final rule incorporates most of the requirements of 42 C.F.R. § 484.20, relating to the electronic reporting of the OASIS data.  CMS, however, has revised the communications requirement that previously required home health agencies to transmit data using electronic communications software that provided a “[d]irect telephone connection from the [home health agency] to the state agency or CMS OASIS contractor.”  Now, CMS permits OASIS data to be transmitted “[i]n accordance with current CMS transmission policy,” which requires home health agencies “[t]o transmit data using electronic communications software that complies with the Federal Information Processing Standard.”
• Patient rights.  This CoP establishes several patient rights, which include among others: (1) the right “[t]o have his or her property treated with respect”; (2) the right “[t]o be free from verbal, mental, sexual and physical abuse, including injuries of unknown source, neglect, and misappropriation of property”; (3) the right “[t]o make complaints to the [home health agency] regarding treatment or care that was (or failed to be) furnished which the patient and/or their family believe was inappropriate”; and (4) the right “[t]o participate in, be informed about, and consent to or refuse care.”

In addition to these rights, this CoP provides that patients and patient representatives are entitled to adequate notice of the patient rights.  Specifically, home health agencies are required to provide patients and patient representatives with verbal notice of the patient rights “[d]uring the initial evaluation visit, and in advance of care being furnished by the [home health agency].”  In addition, the home health agency must provide the patient with a written copy of the patient rights information.

• Comprehensive assessment of patients.  While this CoP retains the majority of the requirements provided in the current § 484.55, CMS expands the CoP to include a new standard, “Content of the comprehensive assessment.”  Specifically, CMS adds “[n]ew content requirements, such as an assessment of psychosocial and cognitive status, which we believe would provide for a more holistic patient assessment.”  This CoP further requires “[t]hat the comprehensive assessment must accurately reflect the patient’s status.” 
• Care planning, coordination of services, and quality of care.  Under this CoP, home health agencies “[h]ave to provide the patient a plan of care that would set out the care and services necessary to meet the patient-specific needs identified in the comprehensive assessment, and the outcomes that the HHA anticipates would occur as a result of developing the individualized plan of care and subsequently implementing its elements.”  In addition, this CoP requires home health agencies to “[i]ntegrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness, the coordination of care provided by all disciplines, and communication with the physician.”
• Quality assessment and performance improvement (QAPI).  The purpose of QAPI is to “[r]educe medical errors” and to “[i]mpove the quality of health care in all settings.”  To accomplish these goals, the final rule replaces two current CoPs—“Group of professional personnel” and “Evaluation of the agency’s program”—and establishes QAPI, which is a data-driven program meant to evaluate and improve home health agency care for patients.
• Infection prevention and control.  CMS organizes this CoP under the following standards:  “(1) Prevention, (2) Control, and (3) Education.”  This final rule directs home health agencies to “[f]ollow infection prevention and control best practices, which include the use of standard precautions, to curb the spread of disease.”  Under the “control” standard, CMS expects home health agencies “[t]o maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases.”
• Skilled professional services.  This new CoP sets forth the requirements for skilled professionals who participate in the interdisciplinary team approach to home health care delivery.  This CoP proposes that skilled professionals “[a]ctively participate in the coordination of all aspects of care where appropriate.”  For purposes of this CoP, “skilled professional services” include “[p]hysician services, skilled nursing services, physical therapy, speech-language pathology services, occupational therapy, and medical social work services.”

To be eligible to provide services to Medicare and Medicaid beneficiaries, home health agencies must meet the above requirements, among others, by July 13, 2017.