The Centers for Medicare & Medicaid Services (CMS) is seeking comments to a proposed rule that would change the current Conditions of Participation that home health agencies (HHAs) must meet to participate in Medicare and Medicaid. According to CMS, the proposed rule represents the first update to the Conditions of Participation for HHAs since 1989. Comments are due by 5 p.m. on December 8, 2014.

The proposed rule includes a new requirement for HHAs to implement a data-driven quality assessment and performance improvement (QAPI) program. According to CMS, the proposed QAPI requirement “mirrors activity already taking place in the HHA industry’s move towards a prospective quality of care approach.” CMS states that the proposed QAPI requirement is based on data already collected in the Outcomes and Assessment Information Set (OASIS) process, CMS-provided patient outcome and process reports, and other current industry efforts.

The proposed rule would also add a new Condition of Participation requiring HHAs to maintain and document an infection control program. In addition, the CMS fact sheet states that the proposed rule:

  • Includes revisions to the OASIS requirements to update applicable electronic data transmissions to meet current federal standards.
  • Expands the current patient rights requirements to clarify the rights of each patient, the process for conducting patient rights violation investigations, and the process for addressing verified violations.
  • Focuses the patient assessment requirement on each patient’s physical, mental, emotional, and psychosocial condition.
  • Adds a requirement that a HHA must maintain a system of communication and integration to identify patient needs, coordinate care provided by all disciplines, and effectively communicate with physicians. This requirement would formalize and shape current, informal communication and coordination structures within HHAs to assure that patients receive the right care from the right discipline at the right time, with the ultimate goal of improving patient care outcomes and efficiency.
  • Condenses the requirements for nursing and therapy services into a single requirement that focuses on integrated patient care planning and delivery, and assures appropriate supervision of all services.
  • Reinforces the current home health aide supervision requirements by requiring additional supervision and training when an agency suspects that home health aide skills are insufficient. \
  • Clarifies the management and administrative structure of HHAs by allowing the administrator to designate an individual to act in his/her absence, which may be the skilled professional that is available during all operating hours.
  • Continues to allow HHAs to have branch offices, but eliminates “subunits.” Designating an HHA location as a “subunit” is a vestige of the old HHA payment system. Under the current payment system, having HHA “subunits” is no longer necessary. This change allows parent agencies to have greater control over all of their offices by placing all locations under the leadership and direct management control of the parent agency. The process for requesting the addition of a branch office would remain unchanged.

HHAs should monitor the proposed rule and consider their readiness for the potential new requirements.