Happy New Year! And with that comes the deadline for commenting on the proposed changes to the current conditions of participation(CoPs) for home health (on Wednesday, January 7th, 2015 at 5:00PMEST). As I ring in the New Year, I always look to start with a clean, updated, upgraded (!) and enhanced slate as a therapist . . . how can I improve myself as a clinician this year? What additional training or education can I seek out to better myself, and through this, advance the care I provide to patients? That has become an ongoing, life-long learning endeavor I set for myself as a therapist.
What about YOU, CMS? Looking at the proposed CoPs, it seems that CMS has also taken inventory of their regulatory materials, and decided to bring requirements for home health agencies (HHAs) current with today’s practices and patient-centered care approaches that I strived to achieve as an agency owner in the past. I applaud CMS on attempting to “get this right” by addressing key concepts in these proposed changes that are overdue. Here is a little background as to why the almost 20 year delay in securing these updates and some highlights of what we can expect with rule finalization.
First, background . . .why proposed changes of 1997 were never finalized by CMS:
“On March 10, 1997 (62 FR 11004), we published a proposed rule,entitled, ‘‘Revision of the Conditions of Participation for Home Health Agencies and Use of the Outcome and Assessment Information Set (OASIS) as Part of the Revised Conditions of Participation for Home Health Agencies,’’ that would have revised the entire set of HHA CoPs. Due to the significant volume of public comments and the rapidly changing nature of the HHA industry at that time, this rule, in its entirety, was never finalized. Rather than finalizing all portions of the March 1997 rule, we published a final regulation (64 FR 3764, January 25, 1999) that only finalized theOASIS regulations.
“. . . Although the OASIS requirements were finalized in separate rules, we intended to proceed with another rule to finalize the remainder of the requirements of the March 1997 proposed rule. However, Section 902 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added section 1871(a)(3) to the Act. This section provided that, effective December 8, 2003, the Secretary, in consultation with the Director of the Office of Management and Budget (OMB), would have to establish and publish regular timelines for the publication of Medicare proposed regulations based onthe previous publication of Medicare propoed or interim final regulations.Section 902 of the MMA further provided that the timeline could vary among different regulations, but could not be longer than 3 years,except under exceptional circumstances. Pursuant to the MMA, we issued a notice implementing this provision in the FederalRegister on December 30, 2004 (69FR 78442). In that notice, we interpreted section 902 as rendering ineffective any proposed Medicare regulations that had been outstanding for 3 years or more as of December 8, 2003; this included the HHACoPs. Therefore, out of an abundance of caution, we decided not to finalize the remaining provisions of the March 10, 1997proposed rule, but begin rule making again.”
Based on this information,I don’t assume that the proposed changes to the CoPs before us now will not be finalized – and neither should you. Some in the industry are presuming such, based on what occurred in 1997.It does not appear to be anything other than a regulatory snafu that prevented the 1997 proposed changes from being finalized.
Second . . . what changes can we expect? And, more importantly, should we embrace these changes?
*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 HHA.
*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.Based on these principles, weare proposing new HHA 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 HHA, and quality assessment and performance improvement efforts. We propose to establish the following four CoPs (in addition to retaining the current requirements at § 484.55, Comprehensive assessment of patients):
*“Patient rights’’would emphasize a HHA’s responsibility to respect and promote the rights of each home health patient.
* ‘‘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.
* ‘‘Quality assessment and performance improvement’’ (QAPI) would charge each HHA with responsibility for carrying out an ongoing quality assessment, incorporating data-driven goals,and an evidence-based performance improvement program of its own design toaffect continuing improvement in the quality of care furnished to its patients.
* ‘‘Infection prevention and control’’ 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 an infection control component into its QAPI program.
In reviewing this information, and the apparent intent behind these changes, CMS has extended the comment period in the hopes of industry feedback. Please don’t miss an opportunity to tell CMSwhat you think – either positive or negative. Every comment is read and really does count! I hope that you will join me in providing CMS feedback on their proposed changes as a way of kicking off a New Year of homehealth!