CMS: New Home Health Rules and Beneficiary Protections

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  • January 9, 2017
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CMS: New Home Health Rules and Beneficiary Protections

A final rule effective July 13, 2017, which the Centers for Medicare & Medicaid Services (CMS) maintains will improve home health care while streamlining providers’ requirements, has been published in the Federal Register.  
Home health patients receive coordinated services ranging from skilled nursing to physical therapy to medical social services, all under the direction of their physician. CMS said there are more than 5 million Medicare and Medicaid beneficiaries receiving home health care from nearly 12,600 Medicare and Medicaid-participating home health agencies, nationwide. The new rule includes a number of changes CMS proposed that it explained reflects current best practices.

Extensive Changes

Changes reflect recent quality based care initiatives found in the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and other Medicare initiatives:

  • A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.
  • An expanded comprehensive patient assessment requirement that focuses on all aspects of patient well being, including psychosocial, functional, and cognitive.
  • A requirement assuring that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform, and the name and contact information of a home health agency clinical manager.
  • A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and  there is active communication between the home health agency and the patient’s physicians.
  • A requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that  evaluates and improves agency care for all patients at all times.
  • A new infection prevention and control requirement focusing on the use of standard infection control practices, and patient/caregiver education and teaching.
  • A streamlined skilled professional services requirement focusing on appropriate patient care activities and supervision across all disciplines.
  • An expanded patient care coordination requirement making a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring  plans of care meet each patient’s needs at all times.
  • Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.
  • New personnel qualifications for home health agency administrators and clinical managers.

Providers will incorporate parts of the OASIS dataset and a new regulation regarding infection control in their work. Caregivers’ definitions are expanded to make more room for differing state practice acts while assuring they are certified and regulated. The new guidelines also simplify and modernize review of records.

Brad Ericson
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Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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