Are there any FAQs for the HHA conditions of participation?
The Centers for Medicare & Medicaid Services is providing a list of FAQs for the Home Health Agency (HHA) Conditions of Participation (CoPs) that became effective on January 13, 2018. Each question includes a response to further clarify the Medicare requirements.
What are the conditions of participation for Medicare?
On this basis, the Conditions of Participation, a set of regulations setting minimum health and safety standards for hospitals participating in Medicare, were promulgated in 1966 and substantially revised in 1986.
What are the guidelines of participation for home health agencies?
CONDITIONS OF PARTICIPATION FOR HOME HEALTH AGENCIES (Effective 01/13/2018) Tag Number Regulation Interpretive Guidelines - Draft 8 G432 (3)Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA;
What is condition of participation for home health aide services?
§ 484.80 Condition of participation: Home health aide services. All home health aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section. ( a) Standard: Home health aide qualifications. ( 1) A qualified home health aide is a person who has successfully completed:
What is Medicare conditions of participation?
Medicare conditions of participation, or CoP, are federal regulations with which particular healthcare facilities must comply in order to participate – that is, receive funding from – the Medicare and Medicaid programs, the largest payors for healthcare in the U.S. CoP are published in the Code of Federal Regulations ...
Which of the following would be considered a patient's place of residence?
Place of Residence A patient's residence is wherever he or she makes his or her home. This may be his or her own dwelling, an apartment, a relative's home, a home for the aged, or some other type of institution.
Which of the following is considered to be the time period after a health policy is issued during which no benefits are provided for illness?
"the policy is issued, during which no benefits would be provided for illness." A Probationary Period in a Health Policy is the time period after the policy is issued, during which no benefits would be provided for illness.
How Long Will Medicare pay for home health care?
Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 30-day period of care. You can have more than one 30-day period of care. Payment for each 30-day period is based on your condition and care needs.
What is a CfC in Medicare?
CMS develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries. CMS also ensures that the standards of accrediting organizations recognized by CMS (through a process called "deeming") meet or exceed the Medicare standards set forth in the CoPs / CfCs.
What is the purpose of health and safety standards?
These health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries. CMS also ensures that the standards of accrediting organizations recognized by CMS (through a process called "deeming") meet or exceed the Medicare standards set forth in the CoPs / CfCs.
What is the current requirement for infection control in HHA?
There is no specific current requirement addressing infection control in the current HHA CoPs. However, current § 484.12 (c), “Compliance with accepte d professional standards and principles, ” requires a HHA and its staff to comply with accepted professional standards and principles that apply to professionals furnishing services in an HHA. Given this broad requirement, we believe that HHA personnel are already using well-documented infection control practices and well-accepted professional standards and principles in their patient care practices. This proposed regulation would reinforce positive infection control practices and would address the serious nature, as well as the potential hazards, of infectious and communicable diseases in the home health environment. This rule would also bring non-accredited HHA quality practices in line with those of their accredited counterparts. The national accrediting organizations have spent a decade or more developing and refining their infection prevention and control standards in the absence of specific Medicare regulations. Indeed, the current infection prevention and control standards established by the accrediting organizations would, we believe, even Start Printed Page 61199 exceed those that we propose to require in this rule.
What is the Office of Minority Health?
This report led to the establishment of the Office of Minority Health (OMH) within the Department of Health and Human Services (HHS), with a mission to address these disparities throughout the Nation. National concerns for these differences in health outcomes between populations, termed health disparities, and the associated excess mortality and morbidity rates have been expressed as a high priority in national health status reviews, including Healthy People 2000, 2010, and 2020. In 2011, HHS also issued the HHS Action Plan to Reduce Racial and Ethnic Health Disparities (found at http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285 ).
How long do HHAs keep clinical records?
All entries in the clinical record would be authenticated, dated and timed, which is usual and customary clinical practice and does not impose a burden. Clinical records would be retained for 5 years after the month the cost report for the records is filed with the intermediary. HHAs would be required to have written procedures that govern the use and removal of records, and the conditions for release of information. This section contains longstanding provisions that are specifically required in section 1861 (o) of the Act, and are necessary to preserve the patient's privacy and the quality of care. While these requirements are subject to the PRA, we believe the associated burden is exempt as stated in 5 CFR 1320.3 (b) (2). The aforementioned documentation and record retention requirements are considered usual and customary business practices and impose no additional burden.
How long does it take to report an Oasis assessment?
Specifically, an HHA would have to encode and electronically transmit each completed OASIS assessment to the state agency or the CMS OASIS contractor within 30 days of completing an assessment of a beneficiary. The burden associated with this requirement is the time and effort necessary to conduct the OASIS assessment on a beneficiary and encode and transmit the information to the State agency or the CMS OASIS contractor. While this requirement is subject to the PRA, the burden is currently approved under the following OMB control number, 0938-0760.
What is QAPI in healthcare?
The quality assessment and performance improvement (QAPI) requirement replaces the current quality-related requirements of § 484.16, “Group of professional personnel,” and § 484.52, “Evaluation of the agency's program.” Quality assessment is already part of standard HHA practice through annual evaluations of an agency's total program using both administrative reviews and a quarterly review of a sample of clinical records. Furthermore, HHAs are already familiar with the basic concept of measuring quality on both a patient and aggregate level. This rule would further refine current HHA quality efforts and bring HHA quality programs in line with their counterparts in a variety of other settings, such as hospitals and hospices. Likewise, this rule would bring non-accredited HHA quality practices in line with those of their accredited counterparts. The national accrediting organizations have spent a decade or more enhancing, expanding, and refining their quality-related standards, and those standards far exceed the current Medicare regulations. Indeed, the current quality-related standards established by the accrediting organizations would, we believe, even exceed those that we propose to require in this rule. Since Start Printed Page 61197 accredited HHAs would already have QAPI programs that meet the requirements of this rule by virtue of meeting the already existing accreditation standards, we are not including accredited HHAs in our analysis of the impact of this requirement. This rule would provide a basic outline of what QAPI is and how we expect it to function in the HHA environment. Each HHA would be free to decide how to implement the QAPI requirement in a manner that reflects its own unique needs and goals.
What is home health insurance?
Home health services are covered for the elderly and disabled under the Hospital Insurance (Part A) and Supplemental Medical Insurance (Part B) benefits of the Medicare program, and are described in section 1861 (m) of the Social Security Act (the Act). These services, provided under a plan of care that is established and periodically reviewed by a physician, must be furnished by, or under arrangement with, an HHA that participates in the Medicare or Medicaid programs, and are provided on a visiting basis in the beneficiary's home. Services may include the following:
What is the purpose of a 484.50?
The purpose is to recognize certain rights that home health patients are entitled to, and protect their rights. HHAs would be required to inform each patient of their rights. In proposed § 484.50, we would require HHAs to inform patients about the expected outcomes of treatment and the factors that could affect treatment. The HHAs are asked to devote efforts to improve patient's health literacy which lead to an increased comprehension of diagnosis and treatment for both patients and family. Increased comprehension allows patients to remain active and make the best possible decisions for their medical care. The requirements currently specified in § 484.10, that are retained in the proposed rule include:
When did HHA COPs become effective?
The Centers for Medicare & Medicaid Services is providing a list of FAQs for the Home Health Agency (HHA) Conditions of Participation (CoPs) that became effective on January 13, 2018. Each question includes a response to further clarify the Medicare requirements.
How often do you have to visit a nurse for HHA?
For patients receiving only HHA aide services, a registered nurse must make an onsite supervisor visit to the location where the patient is receiving care , no less frequently than every 60 days. This visit must occur for each patient in order to observe and assess the aide while performing care. See §484.80(h)(2).
How long does it take to get a clinical record?
A patient’s clinical record (whether hard copy or electronic form) must be made available to a patient, free of charge, upon request at the next home visit, or within 4 business days (whichever comes first). The 4 day clock starts from the time that the patient or representative makes an oral or written request for the clinical record. See §484.110(e).
What is the role of the HHA clinical manager?
Orders from relevant physicians are incorporated into the plan of care and the HHA clinical manager or other staff are responsible for integrating orders from both the responsible physician and any relevant physicians. If the HHA staff have concerns regarding the integration of orders, the staff would work with the relevant physician issuing the order and the responsible physician to resolve those concerns. The revised plan of care may be approved by the responsible physician at the next recertification cycle provided those orders are still active at that time. Short duration orders that are added to the plan of care that are no longer active at the recertification period only need to be approved by the responsible physician if those orders are for services that will be provided by the HHA. The HHA should have policies for the co-signature of orders for services to be provided until the plan of care is signed at the next recertification period. See §484.60.
What is a patient representative?
A patient’s legal representative, such as a guardian, has been legally designated or appointed to make health-care decisions on the patient’s behalf. Evidence that there is a legal representative may include guardianship, a power of attorney for health care decision-making, or a designated health care agent. A patient-selected representative participates at the request of a patient in decisions related to the patient’s care or well-being but is not legally designated or appointed to do so. The patient determines the role of the patient-selected representative.
Can a home health aide be a skilled care patient?
No, a patient receiving home health aide personal care services only is not receiving skilled services. When nurse conducts the supervisory visit for non-skilled services, the patient does not become a skilled care patient. §484.80(h)(1).
Do CoPs require HHA to provide a hard copy of the plan of care?
The CoPs do not require the HHA to provide the patient with a hard copy of the entire plan of care. See 484.60(e).