Understanding the new Conditions of Participation (CoPs)

The implementation date for home health agencies to comply with the new Conditions of Participation (CoPs) requirements is Jan. 13, 2018. On October 27, 2017, CMS released a draft of the Interpretive Guidelines and State Operations Manual for review and comment to select industry groups. The guidelines are intended to describe to the home health industry what it means to CMS to be in compliance with the CoPs. The CoPs have been regrouped into three sections–General Provisions, Patient Care, and Organizational Environment

General Provisions

The General Provisions section of the CoPs establishes the conditions that an HHA must meet in order to participate in the Medicare program and which ensure the health and safety of patients. This section lays out the basis for survey activities to determine if an agency meets the requirements for participation in the Medicare program. This section also defines some of the terms used throughout the CoPs.

Patient Care

The Patient Care section of the CoPs emphasizes patient rights and integrated patient care. The rules for the release of patient information requires a home health agency to ensure the confidentiality of all patient-identifiable information in the clinical record, including the OASIS data. OASIS information must be transmitted electronically in accordance with current CMS transmission policy. The CoPs lay out the information that an agency is required to provide to the patient during the initial evaluation.

The Patient Care section also reorganizes and adds some additional requirements to the patient assessment. Care planning, coordination of services, and quality of care are also addressed in the Patient Care section of the CoPs. HHAs are required to ensure communication with all physicians to assure coordination of services. Patient and caregiver training are addressed including the requirement to provide patients with written schedules for visit frequency, medication, and treatments.

The two new conditions are detailed in the Patient Care section of the CoPs. QAPI required HHAs to measure, analyze, and track quality indicators, including adverse patient events. The data collected and associated quality measures will be used by HHA’s to monitor the effectiveness and safety of its services, as well as to monitor the quality of care. The QAPI program should focus on high risk, high volume, or problem-prone areas of service, and consider the incidence, prevalence, and severity of problems in those areas. HHA performance improvement projects are required to be documented and conducted at least annually.  An additional 6-month phase-in period is allowed for compliance with the performance improvement projects section (July 13, 2018). All other QAPI requirements are effective with the rest of the CoP’s on January 13, 2018.

Infection prevention is the other major new condition introduced in the Patient Care section. This new CoP requires home health agencies to follow infection prevention and control best practices including surveillance, identification, prevention, control, and investigation of infectious and communicable diseases. HHAs must also provide education on current infection prevention best practices to staff, patients, and caregivers.

Organizational Environment

The third section in the CoPs is the Organizational Environment and details the requirements of organizational processes such as administration, personnel, and clinical records. This section of the CoPs requires skilled professionals to participate in coordinating all aspects of care and participate in the HHA’s QAPI program. Home health aide services receive special attention and specify the requirements to qualify as a home health aide including required training, evaluation, and supervision. Emergency preparedness includes a requirement for HHAs to provide individualized emergency plans for patients.

The CoPs define the personnel qualifications for each of the professions within an agency. The clinical manager role is added throughout the CoPs and must be filled by a qualified licensed physician or registered nurse. The clinical manager is responsible for the oversight of all personnel and all patient care.

There are new requirements concerning the parent-branch relationship. To ensure compliance with the CoPs, a parent HHA must demonstrate that it can monitor all services provided by branch offices in its entire service area. Branch locations must be reported to the state survey agency at the time of an agency’s initial certification request, at each survey, and at the time any proposed additions or deletions are made. Home Health sub-units have been eliminated, they must now meet the CoPs independent of their parent agency.

Clinical record retention is now defined as five years after the discharge of the patient. The clinical records must be made available to a patient or appropriately authorized individuals or entities upon request at the next home health visit or within four business days, whichever is earlier.

What Could Have the Biggest Impact on Agencies

The new rules that McBee expects will have the greatest impact on HHAs are the communication requirements, QAPI, and the training and organizational hiring rules. HHAs must assure communication with all physicians involved in the plan of care, and are required to integrate orders from all physicians involved in that care plan. HHAs will be challenged to create a QAPI program that assesses and enhances patient care prior to the CoPs implementation. Hiring qualified individuals could also be a difficult hurdle as agencies must have a licensed clinician to oversee all patient care services. This includes assuring that care plans always meet the needs of patients.