Home Health Agencies Ask for Sufficient Time to Comply With Medicare Changes

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By Michael D. Williamson

Jan. 9 — Home health agencies should have up to 18 months to comply with changes to their Medicare conditions of participation, once they're made final, industry groups said.

The Centers for Medicare & Medicaid Services should “consider the significant time and effort required to invest in training, education and software and systems changes to comply with the new” conditions, Mary Carr, the National Association for Home Care & Hospice's vice president for regulatory affairs, said in a Jan. 7 letter to the CMS responding to an October 2014 proposal.

Granting home health agencies 12 to 18 months of lead time to comply with and implement the new conditions of participation (CoPs) will give the CMS the opportunity to issue “any needed interpretive guidelines and conduct training of state surveyors and providers,” Carr said.

Likewise, in a Jan. 7 letter, Tracey Moorhead, president and chief executive officer of the Visiting Nurse Associations of America (VNAA), told the CMS it shouldn't implement the CoPs until 18 months after they're made final.

The agency also should “provide a one year transition period during which CMS will not sanction providers who are not in full compliance,” she said.

Hospitals' Concerns 

A hospital trade group also submitted comments on the CoPs.

Noting that the CMS didn't propose a timeline for implementing the new CoPs once they're made final, Rick Pollack, executive vice president for the American Hospital Association (AHA), requested an effective date for the CoPs that is one year after the final rule is released.

“This timeframe would allow HHAs [home health agencies] sufficient opportunity to incorporate new policies, procedures and practices effectively,” Pollack's Jan. 5 letter said.

The AHA noted that it was commenting on behalf of our nearly 5,000 member hospitals, health systems and other health-care organizations, “including almost 1,000 that have home health services.”

The groups sent in their comments in response to an Oct. 9, 2014, proposed rule (79 Fed. Reg. 61,164; CMS–3819–P) that outlined new conditions for home health agencies for the first time since 1989.

Originally, comments were due Dec. 8, 2014.  In an early December 2014 notice (79 Fed. Reg. 71,081, Dec. 1; CMS–3819–N), the CMS extended the comment period until Jan. 7.

A White House fact sheet from Oct. 6, 2014, said the CoPs proposed rule includes “an expanded comprehensive patient assessment requirement that focuses on all aspects of patient well-being” and “an expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient's needs at all times.”

The White House document noted that approximately 12,500 home health agencies participate in Medicare, and there are more than 5 million people with Medicare and Medicaid benefits who receive home health-care services each year.

Overall Support 

Each of the three groups said they generally support the proposed CoPs.

“Many of the proposed changes will result in improved patient care by allowing agencies to focus their efforts on processes and initiatives that have a direct impact on high quality care,” the home care and hospice group said.

The VNAA agreed with many of the updated CoPs. Several of the proposed changes “align with recommendations that VNAA and its members have long supported,” Moorhead said.

In addition, the hospital group supported the new home health CoPs. “We applaud CMS for continuing to update CoPs for health care providers and to ensure that regulations are current, reflect the best and most knowledge about care delivery, and embody high expectations for quality of care,” the group said.

Personnel Qualifications

Even though the groups largely praised the revised CoPs, two asked the CMS to change language stipulating what qualifications certain personnel need.

The home care and hospice called on the CMS to modify the proposed rule's definition of a “physician.” According to the group, the rule's proposed definitions for physician are inconsistent with regulations governing “the types of physicians who may certify, establish and review the plan of care for home health services in the current and proposed CoPs.”

Similarly, the proposal contains qualification discrepancies for occupational therapist, occupational therapy assistant, physical therapist and physical therapy assistant and should be clarified, the AHA said.

To contact the reporter on this story: Michael D. Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

The National Association for Home Care & Hospice's letter is at http://op.bna.com/hl.nsf/r?Open=mwin-9slpm2.

The VNAA's letter is at http://op.bna.com/hl.nsf/r?Open=mwin-9sls3m.

The AHA's letter is at http://op.bna.com/hl.nsf/r?Open=mwin-9sls4z.

The CMS's proposed rule is at http://www.gpo.gov/fdsys/pkg/FR-2014-10-09/pdf/2014-23895.pdf.

The notice extending the comment deadline is at http://www.gpo.gov/fdsys/pkg/FR-2014-12-01/pdf/2014-28266.pdf.

The White House fact sheet on the new CoPs is at http://www.whitehouse.gov/the-press-office/2014/10/06/fact-sheet-administration-announces-new-executive-actions-improve-qualit.