New Conditions of Participation Proposed for Home Health Agencies

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By Michael D. Williamson

Oct. 6 — The CMS Oct. 6 released a proposed rule revising the current conditions of participation that home health agencies must meet to participate in the Medicare and Medicaid programs.

The Centers for Medicare & Medicaid Services proposed four new home health agency (HHA) conditions of participation (CoPs) in the rule. In addition, the CMS revised several CoPs for HHAs.

According to the rule, “The proposed requirements would focus on the care delivered to patients by home health agencies, reflect an interdisciplinary view of patient care, allow home health agencies greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements.”

The proposed rule (CMS-3819-P, RIN 0938-AG81) is set for publication in the Federal Register Oct. 9. Comments are due Dec. 8.

In a fact sheet, the White House 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 Office of Management and Budget May 22 began reviewing the proposed rule. The CMS hasn't updated the CoPs since 1989.

At the time of the OMB review, home health industry stakeholders said the CoP proposal had been in the works for more than 10 years.

One industry group appeared willing to work with the CMS as the agency implements the new and revised CoPs.

In a statement emailed to Bloomberg BNA Oct. 7, Val Halamandaris, president of the National Association for Home Care & Hospice (NAHC), a home health industry group, said, “We want to work closely with the Medicare program and other stakeholders on this effort to modernize the Home Health Conditions of Participation. Our goal is to help the home care industry maintain its high standards to the benefit of the venerable population we serve.”

The NAHC statement said the group “is currently assessing the proposed rule.”

New CoPs 

In the rule, the CMS proposes to establish new:

• patient rights measures, which “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 measures, which “would incorporate the interdisciplinary team approach”;

• quality assessment and performance improvement (QAPI) measures, which “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 to affect continuing improvement in the quality of care furnished to its patients”; and

• infection prevention and control measures, which “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.”


Revised CoPs

According to the proposal, the revised CoPs “retain and/or include process-oriented requirements that are predictive of ensuring desired outcomes.”

The CMS said, “We propose to eliminate many of the process details from the current requirements where they do not achieve this goal.” In addition, other process detail requirements will be modified by referencing current clinical practice guidelines and professional standards specific to home care.

Moreover, the CMS said, “We also propose to remove the requirements that the HHA send a summary of care to the attending physician at least once every 60 days, that the HHA have a group of professional personnel to advise its operation, and that the HHA conduct a quarterly evaluation of its program via chart reviews.”

To contact the reporter on this story: Michael D. Williamson in Washington at

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

The proposed rule is at


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