Major Changes Announced Regarding Home Health Care and Other Long Term Providers Standards/Conditions of Participation

There have been two major changes announced by the federal government that affect Home Health Agencies (“HHAs”) and other Long Term Care Health Providers.  On October 6, 2014, President Obama signed into law the Improving Medicare Post-Acute Care Transformation Act of 2014 (“IMPACT Act of 2014”).   Concurrently, on the same day, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule to make changes to the Conditions of Participation for home health agencies (“HH-CoP”), which appeared in the Federal Register on October 9, 2014.

1.    
IMPACT ACT of 2014

The major provisions of the legislation was a Standardization of Post-Acute Data. CMS is going to require the standardization of assessment data for all post –acute care (“PAC”) providers.  The Act defines PAC Providers as HHAs, skilled nursing facilities (“SNFs”), Inpatient Rehabilitation Facilities (“IRFs”) and long-term care hospitals (“LTCHs”).  The Medicare Act is amended to add new Section 1899B.  The Act requires PAC providers to report standardized patient assessment data and requires PAC providers to report standardized quality measures and resource use measures. The Act also requires the Secretary of Health and Human Services (“HHS”, “Secretary”) to modify PAC assessment instruments to allow for the submission of standardized patient assessment data and to allow for comparison of such data across all such providers.

The IMPACT Act requires PAC providers to report standardized patient assessment data under the applicable reporting requirements by October 1, 2018 for SNFs, IRFs and LTCHs and by January 1, 2019 for HHAs.  At a minimum, the Secretary shall require reporting at times of admission and discharge.  The standardized patient assessment data shall include functional status, self-care at admission and PAC provider discharge, cognitive function and mental status, special services, medical condition, impairments, prior functioning levels, and other categories the Secretary deems appropriate and necessary.  By October 1, 2018 for SNFs, IRFs and LTCHs and by January 1, 2019 for HHAs, the Secretary shall ensure a match between the patient assessment data submission and any claims data that is also submitted for such patient.  The Secretary shall use the matched data to assess prior and concurrent service use and for any other appropriate purposes. 

The Secretary shall specify additional quality measures that PAC provides are required to submit under the applicable reporting provisions, starting on October 1, 2016 for SNFs, IRFs, and  for HHAs  on either January 1, 2017 or January 1, 2019 for five (5) quality domains: functional status and changes in function; skin integrity and changes in skin integrity; medication reconciliation; incidences of major falls and patient preference regarding treatment and discharge options.  By October 1, 2018 and by January 1, 2019 for HHAs, the Secretary shall create procedures for making available to the public information pertaining to individual PAC performance related to the resource use measures.
HHS has created payment consequences under the applicable reporting provisions.  In addition, HHS has created Hospice survey and certification requirements, requiring routine Hospice surveys at least once every three years, conducting focused medical review of Hospices with long stays (patients receiving care for more than 180 days) , and updated the Hospice payment cap, tying the hospice cap to the hospital market basket. 

2.     HH-C o Ps

The Proposed Rule would modernize Medicare HH-CoPs for the first time since 1989, to ensure safe delivery to the quality care to home health patients.  The proposed regulation emphasizes patient rights, improves the process of care planning delivery and coordination, streamlines regulatory requirements and encourages ongoing data-driven quality improved.  The revised CoPs would focus on patient outcomes, provide for continuous and ongoing quality assessment and performance improvements.  HHS will eliminate many of the process details from the current requirements that do not achieve predictability and ensure desire outcomes. For example, HHS will not incorporate any specific clinical practice guideline or professional standards of practice; rather the HHA would be responsible for identifying its own performance problems through a QAPI program addressing them and continuously striving to improve the quality of clinical care, patient outcomes and satisfaction, as well as efficiency and economy.  HHS will 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 review.   Comments are due to CMS by December 9, 2014.   

Should you wish additional information or if you have questions regarding this article, please do not hesitate to contact Charles MacKelvie at (312) 235-1117 of Meghan McNab at (317) 808-5863.