The Centers for Medicare & Medicaid Services (CMS) has proposed delaying the implementation date for the new home health Conditions of Participation (CoPs) until January 2018. The proposal comes after home health industry associations and providers pushed back against the original implementation timeline for the CoPs, which were finalized in early January 2017.
Instead of going into effect on July 13, 2017, the new CoPs—which govern how home health agencies qualify to participate in Medicare and Medicaid—would go into effect on January 13, 2018, under a proposed rule issued Friday by CMS. The proposed rule is subject to a 60-day public comment period, following its publication in the Federal Register, scheduled for April 3.
CMS also seeks to push back the phase-in date for the data-driven performance improvement projects requirements, to six months after the new compliance date. That means agencies would need to be in compliance with this aspect of the new rules by January 13, 2018. All administrators grandfathered prior to the effective date of the CoP final rule would also not have to meet new personnel requirements until the new effective date in 2018.
The revised implementation period is likely good news for home health care agencies, many of which vocalized concern over the original six-month compliance period. The updated CoPs are the first major change to the requirements in the last two decades. CMS seeks to delay implementation in response to public comments, citing “the concerned expressed in the inquiries have merit.”
Implementing the new CoPs is expected to be costly for providers, reaching an estimated $293.3 million in the first year alone, and $290.1 million in subsequent years. The cost to an individual home health care agency is estimated at $30,000, according to the National Association for Home Care & Hospice (NAHC). The association expressed support for the proposed delay.
“We are very pleased that CMS has proposed to extend the effective date of the CoP rule,” Bill Dombi, vice president for law at NAHC, told Home Health Care News. “NAHC had requested the extension after 75% of our members indicated that compliance by the planned July 13, 2017 date was not realistic. Given that the rule was in development for 20 years, it is appropriate to set a reasonable compliance deadline. We are now headed in that direction.”
Some of the biggest changes outlined in the updated CoPs include the inclusion of a patient bill of rights, additional training, administrative and organization requirements, and a new quality assessment and performance improvement (QAPI) provision. Industry groups have been generally supportive of the updated conditions, but sought more time to comply.
Lawmakers, too, were pushing for a delay to give agencies more time to comply with the significant changes. The Home Care Association (HCA) of New York worked with New York Congressman John Faso to urge CMS to delay the effective date as recently as March 27, when Rep. Faso sent a letter to CMS Administrator Seema Verma.
“Home care providers understand the rationales and goals of the CoP changes, and they report vigorous and hurried efforts to get their staff trained and ready,” the letter reads. “Moving back implementation by six months will allow for all parties involved to be better prepared to operate and ultimately provide quality care to home care beneficiaries.”
Agencies were also waiting with baited breath for CMS’ interpretive guidance on the rules—which has yet to be issued—to better understand how to comply with the changes. The Visiting Nurse Associations of America (VNAA) supports the delay in the effective date, in part because CMS has not issued this interpretive guidance yet.
“VNAA applauds the delay announced by CMS, as we had previously called for CMS to release the CoP Interpretive Guidelines not later than March 8, 2017,” Joy Cameron, vice president of policy and innovation at VNAA, told HHCN. “VNAA believes these guidelines are critical to effective implementation and should be supported by significant CMS outreach and education efforts. The Interpretive Guidelines are regularly used by home health agencies, state survey agencies and accreditation agencies to better understand the CoPs, and have been an essential tool to ensure appropriate implementation and compliance.”
The delay is a welcome sign for home health advocates who have been hoping for some regulatory relief, though the industry is still fighting for a delay or moratorium on the controversial Pre-Claim Review Demonstration (PCRD), set to take effect April 1 in Florida.