CMS announced a Final Rule document on July 10, delaying the effective date for the updated Home Health Agency Conditions of Participation (HH CoPs) for Medicare and Medicaid agencies. This final rule delays the effective date from July 13, 2017, to January 13, 2018, and will confirm date changes for the Administrator and QAPI Projects of the HH CoPs.
The Medicare and Medicaid HH CoPs proposed rule originated nearly three years ago on October 9, 2014. After a mandatory, 60-day comment period, a notice of an additional 30-day comment period was published. This comment period ended January 7, 2015, and after careful review of the numerous suggestions, the final HH CoPs were published on January 7, 2017, with an original implementation date of July 13, 2017.
The January 2017 HH CoPs revised the conditions home health agencies must meet, should they choose to participate in Medicare and Medicaid programs. New requirements focus on HHA care delivery to patients and reflect an interdisciplinary-team view of patient care. The goal is to increase patient involvement and improve outcomes, while improving patient satisfaction with the provided HHA services.
The updated HH CoPs do not specify how agencies are to implement the changes to comply, as CMS addresses this directly. CMS states that the intent is to allow agencies to be innovative with processes to realize the desired outcomes, rather than mandate a specific process that all agencies must follow.
Due to the significant changes, numerous comments were submitted regarding the six-month timeline for implementation. CMS determined the requests for additional preparation time had merit, and therefore, on April 3, 2017, it published a proposed rule to delay.
Many agencies and industry experts have questions regarding the Interpretive Guidelines and survey process expectations during implementation, as the Surveyor’s Guidance Manual is not yet published. CMS addressed this in the recent Final Rule announcement, by explaining “Existing Guidance to Surveyors for home health agencies can currently be found in Appendix B of the State Operations Manual. Updates to the Interpretive Guidelines to reflect the requirements of the January 2017 HH CoPs final rule are currently under development. We expect a preliminary draft of the revised guidelines to HHA stakeholders for informal input in the fall of 2017.”
This draft will publish with a comment period for stakeholders, with the final version scheduled to be published in December 2017. CMS goes on to state that even absent a final version, surveyors will be able to survey home health agencies to assess compliance with the new CoPs . Therefore, a delay in the release of the Interpretive Guidelines would not result in a further delay of the HH CoPs.
Agencies need to use the current, six-month extension to prepare for the comprehensive changes in the updated HH CoPs regulation. Important implementation dates are:
- Effective date of the revised Medicare and Medicaid Home Health Agency Conditions of Participation: January 13, 2018
- Effective date of new Administrator Standards at §484.115(a)(1) and (2): January 13, 2018
- Phase-In date of QAPI (quality assurance and process improvement) Project requirements at §484.65(d): July 13, 2018
Agencies should also be aware, that though Emergency Preparedness (EP) regulations were added to the final version of updated HH CoPs, the implementation timeline for EP is different than the dates provided above. EP regulation is tied to separate rulemaking (81FR 63859), which was finalized in September 2016 with an implementation date of November 15, 2017. The updated EP regulation is extensive, and will likely require extensive preparation.
Axxess is your partner in education and preparation for all ongoing regulation changes. Stay up to date with the latest changes and follow our blog and on-demand video training series on the Home Health Agency Conditions of Participation and Emergency Preparedness regulations for Medicare and Medicaid participants.
