Medicare-Medicaid Home Health Rule Delayed Six Months

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By Mike Stankiewicz

Updated home health requirements under Medicare and Medicaid, including minimum health and safety standards, won’t take effect until early 2018.

The Centers for Medicare & Medicaid Services in a final rule (RIN:0938-AG81) released July 7 pushed back the effective date of home health providers’ conditions of participation by six months, from July 13, 2017, to Jan. 13, 2018. The updated conditions of participation were originally published in January 2017 by the Obama administration and were the first rewrite of the standards for home health providers since 1989.

The requirements will affect the nearly 12,600 Medicare- and Medicaid-participating home health agencies in the U.S., which serve more than 5 million Medicare and Medicaid beneficiaries.

The CMS acknowledged that the new conditions of participation “contain numerous changes that require time for planning, testing, training, and implementation. In order to assure that [home health agencies] have adequate time for all preparation activities, we are finalizing the proposed 6 month delay.”

Industry reaction to the delay has been mostly positive. “We are pleased with the CMS’s action,” William Dombi, vice president for law at the National Association for Home Care and Hospice (NAHC) in Washington, told Bloomberg BNA July 7. “This is a very significant rule for home health agencies, and they just need more time to implement these changes.” Dombi is a Bloomberg BNA advisory board member.

The American Hospital Association applauded the CMS in an email to Bloomberg BNA July 7 for “giving home health agencies a longer timetable for implementing the requirements in the updated Home Health Agency Conditions of Participation. This will help ensure that home health agencies, especially smaller organizations, have the time needed to meet the many new regulations required of them.”

Joy Cameron, vice president of policy and innovation at the Visiting Nurse Associations of America in Arlington, Va., said she was happy with the six-month delay, but stressed the need for more clarifying guidance for home health agencies.

Regarding the delay, she told Bloomberg BNA July 7: “This is as good as we’re going to get.”

New Requirements

The final rule requires that patients receive written information about upcoming visits, medication instructions, treatments administered, and instructions for care that the patient and caregivers perform, among other things.

“The process of patient communication, both verbally and written, requires major changes in the agencies,” Dombi said. “For example, if there is a change in a plan of care, it needs to be communicated to the beneficiary verbally in ‘conversational tone.’”

The rule also requires an integrated communication system that helps coordinate care for patients and promotes communication between a home health agency and patients’ doctors.

“The rule requires home health agencies to establish a quality assurance and performance improvement program,” Dombi said. “It takes time from the design to communication to staff and training to get it done right.”

More Guidance Coming

In comments to the CMS, some industry groups and home health agencies urged the agency to work with stakeholders to develop further guidance to help home health agencies comply with the new requirements. Some groups, including the NAHC, said the rule should be delayed until six months after additional guidance is released. The CMS rejected their recommendations.

“We do not believe that delaying the effective date of the new [home health agency conditions of participation] beyond January 2018 would be in the interest of improving patient safety and quality of care,” the CMS said in the July 7 final rule.

The CMS also said updates to already available guidance are currently under development and that a draft of the revised guidelines could be made available in the fall to some home health agencies, with a final version published in December.

“We still believe that it is very important for the CMS to issue the interpretive guidelines sooner rather than later,” Dombi said. “Giving about a one-month advance warning of compliance standards in the interpretive guidelines is insufficient if the guidelines contain anything of real substance, as they do currently.”

Cameron said the CMS should offer as much education as possible for home health agencies and answer all questions regarding compliance prior to the guidance’s release.

“We need this information to make sure everyone is on the same page,” she said. “We will need a lot of clarity in a short amount of time.”

Dombi said “if we determine that the guidelines prescribed certain actions that are not necessarily obvious from the language of the rule, we will ask that CMS extend the effective date again. When it’s something that’s 20 years in the process, it’s better to do it right rather than to meet some artificial deadline.”

To contact the reporter on this story: Mike Stankiewicz in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

The CMS rule is at

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