CMS Issues Final Rule to Revise Home Health Conditions of Participation

George IndestBy George F. Indest III, J.D. M.P.A., L.L.M., The Health Law Firm

On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in the Medicare and Medicaid. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards and eliminate unnecessary procedural requirements. The provisions of this rule will go into effect on July 13, 2017.
Patient Centered Process.

CMS’ focus on a patient-centered process is notably reflected by a restructuring of Part 484 into two parts: (1) home health patient care, and (2) HHA organization and administration. The restructured new Part 484 offers expanded patients’ rights to participate in and to set goals toward care and treatment, through new and revised rules, covering admission to discharge or transfer.

The new Patient Rights Notice (PRN) under Part 484, includes patients’ right to actively participate in their initial and follow-up assessments, to develop and update their plan of care (POC) and discharge and transfer plans. Patients may also participate in deciding care preferences as well as expected outcome and measurable goals.

Under the provisions, in order to expand patient access to the PRN, an HHA must provide the PRN to patients and their representatives. It must be laid out in a writing, in a language and manner that is clearly understood. For patients and their legal representatives, the writing must further be understandable to persons who have limited English proficiency and accessible to individuals with disabilities. For patients, this means accessible websites and auxiliary aids and language services at no cost to them. Further, an HHA must provide verbal explanation of the PRN to the patient, in the patient’s primary or preferred language and in a manner the patient understands, free of charge, using an interpreter if necessary.

According to CMS, a more comprehensive understanding of patients’ status will increase the likelihood of achieving their desired outcomes. Therefore, the POC requirements have been expanded to more accurately explain the patient’s status.

Data-Driven Solutions.

To focus on data-driven solutions, CMS implemented evidence-based health care solutions by the use of the Quality Assessment and Performance Improvement (QAPI) program. The QAPI program must further measure, analyze, and track quality indicators to assess the HHA’s care processes, services, and operations. The program may use OASIS data, measurement and tools, or other relevant sources.

Outcome-Oriented Results.

According to CMS, the restructuring will better implement home health care coordination and achieve outcome-oriented results. These changes to Part 484 are part of the CMS’s overall effort to achieve broad-based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers.

To read the final rule issued by CMS, click here.

To learn more about HHAs and compliance, click here to read one of our prior blogs.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at


Baxter, Amy. “CMS Issues Final Rule to Modernize Home Health Conditions of Participation.” Home Health Care News. (February 24, 2017).

Lipschitz, Benjamin. “Revised Conditions of Participation for Home Health Agencies.” AHLA. (February 24, 2017). Web.

About the Author:
Michelle L. Bedoya is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

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