CMS Home Health Conditions of Participation (CoP) Updated for 2017 (now 2018- DELAYED) in New Final Rule

 In Home Health, Industry News, News, Regulatory

Update January 13, 2018: CoP’s in effect, but no final Interpretive Guidelines

The new Home Health Conditions of Participation are now in effect, however, there is no news about a final version of the Interpretive Guidelines. The draft copy was published in October (see below), and both ElevatingHome and NAHC (National Association for Home Care and Hospice) have submitted comments to CMS.

Update December 1, 2017: Update on sub-units for HHA’s

CMS has published supplemental information around the elimination of the definition for sub-unit home health agencies. 

Update October 30, 2017: Draft of Interpretive Guidelines

A DRAFT copy of the home health conditions of participation interpretive guidelines 2018 has been published, which likely means there will not be another delay of the new CoP’s. More information as it becomes available. The guidelines may be found here.

Update July 10, 2017: CoP’s Delayed

The industry sighed a collective breathe of relief as CMS has announced the new Home Health Conditions of Participation will be delayed by 6 months to January 13, 2018. The announcement is to be made in the Federal Register and can be directly found here. It was widely expected the new Home Health CoP’s would be delayed, but in an industry with multiple regulatory requirements, there was much uncertainty as the original July 13, 2017 date approached.

As announced previously, DeVero is prepared for the original Home Health CoP deadline.

Update June 20, 2017: DeVero Announces HH CoP Resource Page

Please bookmark our Home Health Conditions of Participation Resources page for news as we approach the implementation date of the new rule.

New rule to take effect July 13, 2017  January 13, 2018 with emphasis on Care Coordination and Patient Rights

In the first update since 1997, the Centers for Medicare & Medicaid Services (CMS) published a new final rule for the Conditions of Participation (CoPs) that is to take effect July 13, 2017. However, on March 30, 2017, the Department of Health and Human Services followed up by posting an update regarding Medicare and Medicaid Programs Conditions of Participation (CoP’s) for Home Health Agencies. The update includes a Proposed Rule that would delay the new CoP’s for six months, moving the effective date from July 13, 2017 to January 13, 2018. This Proposed Rule is subject to a 60-day public comment period, followed by publication in the Federal Register, which was scheduled for April 3rd.

Following the January 2017 release of its final rules governing home health agencies, the Centers for Medicare & Medicaid Services (CMS) is hoping its new guidelines “improve the quality of healthcare services for Medicare and Medicaid patients and strengthen patients’ rights.” For all those who work in home health, these Conditions of Participation (COP) are the minimum health and safety standards that must be must be met to participate in Medicare and Medicaid programs.

Most of these new rules are scheduled to take effect July 13, 2017 (pending the proposed rule delay) and represent a major revision in several areas, which CMS says are meant to streamline requirements for providers. At a high level, the final rule includes: a patient rights condition of participation that lays out the rights of home health agency patients and the steps that must be taken to assure those rights, as well as an expanded assessment requirement that focuses on all aspects of patient well-being and a requirement that assures 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.

There are many more facets to the rule. CMS now requires an “integrated communication system” that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active communication between the home health agency and the patient’s physician(s). Also, the rules require a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that continually evaluates and improves agency care for all patients at all times.

During a recent DeVero-sponsored webinar that featured speaker Michael Tidd of Healthcare Synergy, an expert with 18 years of home health experience, he detailed these and other changes in the new COP. Tidd pointed out that home health agency administrators are now held to a much higher standard than in the past. For example, administrators must now be aware of activities and patient prognosis of each of the branches that they manage, all day, not just their primary facility.

The new rules, though, are designed primarily for one reason: to expand patient rights, focus on care coordination and planning, and expand assessment processes, Tidd said. To that effect, there are five principles of change:

  • Increased focus and enforcement of patient rights;
  • Increased quality of care through monitoring of assessment data for performance specific to each agency;
  • Removing administrative focus of projects that lack adequate evidence of predicting or obtaining improved or preventing harmful patient outcomes;
  • Improving patient centered interdisciplinary coordination of care to meet the needs of the patient; and
  • Building a continuous, integrated care process utilizing all disciplines for a patient assessment, care plan and delivery to provide quality and performance.

The expanded patient care coordination requirements makes a licensed clinician responsible for all care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times while requiring new infection prevention and control requirement.

The impact to HHA agencies includes new personnel qualification requirement that means an agency can’t refuse care to a patient in the event that the agency’s staffing level changes. Even more comprehensively, there is a major focus on the Quality Assessment and Performance Improvement (QAPI) Standards, which mandate that HHAs develop, implement, evaluate and maintain an effective, ongoing, HHA-wide, data‐driven QAPI program. Specifically, the HHA’s governing body must: ensure that the program reflects the complexity of its organization and services; involves all HHA services (including those services provided under contract or arrangement); focuses on indicators related to improved outcomes, including hospital admissions and re-admissions; and takes actions that address the HHA’s performance across the spectrum of care, including the prevention and reduction of medical errors. The HHA must maintain documentary evidence of its QAPI program and be able to demonstrate its operation to CMS.

Other major program evolutions affect sections to Infection Prevention and Control that dictate that HHAs must maintain and document an infection control program, the goal of which is prevention and control of infections and communicable diseases. The infection control program must include: a method for identifying infectious and communicable disease problems and a plan for the appropriate actions that are expected to result in improvement and disease prevention.

The new rules also mandate changes to the clinical manager’s role and other staff qualifications. To put the patient back in focus, there are significant changes to the clinical record (484.110), specifically including:

  • Contact information for the patient and the patient’s representative (if any);
  • Contact information for the primary care practitioner or other healthcare professional who are responsible for providing care and services to the patient after discharge from the HHA;
  • Completed discharge summary that is sent to the primary care practitioner who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within five business days of the patient’s discharge;
  • Completed transfer summary that is sent within two business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or
  • Completed transfer summary that is sent within two business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a healthcare facility at the time when the HHA becomes aware of the transfer.

Finally, HHAs must be capable of showing measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety and quality of care.

All provisions in excerpt one QAPI Standard take effect on July 13, 2017, while QAPI 484.65.d doesn’t go into effect until January 2018.

While Kate Goodrich, MD, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, said the “announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholders and medical evidence,” given the exhaustive changes coming later this year, there’s ample reason to take notice of the rules, but no need to be concerned.

However, HHAs must begin the process of preparing and readying for these changes soon, likely no later than May 2017, Tidd told attendees of the webinar.

Much must be done, that’s clear, but there’s a great deal of help available, such as the experts at Healthcare Synergy and DeVero. For immediate overview of CMS’ COP changes, including changes to definitions, codes and other exhaustive details of the rules, please review DeVero’s webinar, “Home Health Conditions of Participation 2017 Overview,” found here:

The new rule with CoP updates will impact nearly 12,600 home health care agencies participating in Medicare and Medicaid nationwide, representing care provided to over 5 million patients. This announced timeline offers agencies just six months to understand the regulations, prepare, and implement compliance standards in the new rule.

The new rule may be found here:


There are a number of resources available to agencies, including this new page of resources. We suggest looking to consultants, state home health organizations and home health software vendors to follow information on adopting the new standards in the rule.

**UPDATE: DeVero hosted a webinar to cover this topic which was open to the home health community. You may view the home health CoP webinar here. Clients using DeVero home health software will be notified through email. If you’re not a client, please sign up for the webinar or through our News and Updates (below) to ensure you’re notified.

DeVero has also launched a Free Resources page to monitor resources available to the home health industry. Please bookmark it:

For more information and analysis on the new Home Health CoP’s, we recommend:


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