On October 6, 2014, a proposed regulation was issued that would modernize home health regulations for the first time since 1989. According to the Centers for Medicare & Medicaid Services (CMS), the proposed requirements focus on the care delivered to patients by home health agencies (HHAs), reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. CMS views these changes as an integral part of its overall effort 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.

Incorporated within the regulation are an expansion of patient rights requirements; refocusing of the patient assessment on physical, mental, emotional, and psychosocial conditions; improved communication systems and requirements for a data-driven quality assessment and performance improvement (QAPI) program. More specifically, the proposed rule includes the following:

  • 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, reinforcing that it is the HHA’s responsibility to respect and promote the rights of each home health patient.
  • Incorporates a new requirement for each HHA to develop, implement, and maintain an agency-wide, data-driven QAPI program of its own design to affect continuing improvement in the quality of care furnished to its patients.
  • 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 and skilled professionals. This requirement would formalize and shape current, informal communication and coordination structures within HHAs to assure an interdisciplinary team approach focusing on the care planning, coordination of services, and quality of care processes so 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.
  • Addresses a new infection control requirement that would require HHAs to follow accepted standards of practice to prevent and control the transmission of infectious diseases and to educate staff, patients, and family members or other caregivers on these accepted standards. The HHA would be required to incorporate detailed infection control components into its QAPI program. These requirements will likely require significant adjustments for most agencies in terms of resources and operations.
  • 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.
  • Includes revisions to the Outcomes and Assessment Information Set (OASIS) requirements to meet current federal electronic data transmissions standards.
  • Proposes to eliminate “subunits” designations and eventually require current subunits to be converted to either a parent agency or a branch.

CMS’s stated goal through the regulation is to ensure quality health care for beneficiaries from CMS-certified providers by taking advantage of advances in the health care delivery field. Through instituting the changes in the proposed rule, CMS hopes to achieve a balanced regulatory approach by ensuring that a HHA furnishes health care that meets essential health and quality standards, while ensuring that it monitors and improves its own performance.