On October 9, 2014, CMS published in the Federal Register a Proposed Rule that would revise the home health Conditions of Participation (CoPs). The home health CoPs have not been updated since 1989. Although CMS previously proposed revisions to the home health CoPs on March 10, 1997, CMS never finalized those proposed revisions due to the “significant volume of public comments and the rapidly changing nature of the [home health] industry.”

According to CMS, CMS considered, among other things, the public comments received in response to the March 1997 proposal and industry developments when revising the home health CoPs. CMS identifies the following principles used to develop the new home health 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 for patients or preventing harmful outcomes for patients.
  • Safeguard patient rights. CMS proposes new home health CoPs that would revise or eliminate many current requirements and would focus provider efforts on the services delivered to the patient, the quality of care furnished by the home health agency, and quality assessment and performance improvement efforts.

CMS proposes to establish the following four CoPs (in addition to retaining the current requirements at § 484.55, comprehensive assessment of patients): 

  1. “Patient rights” would emphasize a home health agency’s responsibility to respect and promote the rights of each home health patient.  
  2. “Care planning, coordination of services, and quality of care” would incorporate the interdisciplinary team approach to provide home health services focusing on the care planning, coordination of services, and quality of care processes.  
  3. “Quality assessment and performance improvement” (QAPI) would charge each home health agency with responsibility for carrying out an ongoing quality assessment, incorporating 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.  
  4. “Infection prevention and control” would require home health agencies 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 home health agency would be required to incorporate an infection control component into its QAPI program.

The Proposed Rule is available by clicking here. The CMS Fact Sheet is available by clicking here.

Comments on the Proposed Rule are due by December 8, 2014.