On September 17th, CMS held a public event to share its proposal to reform several home health and hospice regulatory requirements. The proposal includes changes to current home health and hospice regulatory requirements, Conditions of Participation (CoPs), and Conditions for Coverage. According to CMS, this will “simplify and streamline the current regulations and thereby increase provider flexibility and reduce excessively burdensome regulations, while also allowing providers to focus on providing high-quality healthcare to their patients.” The good news for providers is that the focus of these reforms is to reduce burdens and control costs.
There are three categories of proposed reform. They are:
- Proposals that simplify and streamline processes;
- Proposals that reduce the frequency of activities and revise timeliness; and
- Proposals to address obsolete, duplicated, or unnecessary requirements.
Here’s a summary of the proposal:
Proposed Hospice Regulatory Reforms
Hospice Medication Management Requirements
Today, hospices must have a staff member with specialty knowledge of hospice medications. However, most hospices now contract with pharmacy benefit management companies. So, it’s no longer necessary to include a requirement specifically related to using a pharmacology expert. By removing this requirement, CMS believes that hospices may benefit from a cost savings because they won’t need to dedicate time during IDT/IDG meetings to document compliance.
Additionally, CMS recommends replacing the requirement that hospices must provide a copy of medication policies and procedures to patients, families, and caregivers. Instead, hospices would have to provide the patient/patient representative and family with information on the use, storage, and disposal of controlled drugs in a user-friendly format determined by the hospice.
Hospice Aide Training & Competency Requirements
Currently, under 418.76 of the Hospice CoPs, hospice aides are required to meet training or competency requirements that mirror requirements established in the Home Health CoPs. CMS recommends removing the part that requires state licensing programs meet specific training and competency requirements (418.76(b) and (c)) to be deemed an appropriate qualification for employment. Instead, CMS would defer to state licensing requirements, allowing each state to define training and competency requirements that best meet the needs of its population.
Consequently, CMS acknowledges that deferring to state requirements could introduce a new level of variability in hiring processes. But, it believes that remaining CoPs should ensure that patients and families continue to receive services that meet their needs.
Hospices Care for SNF/NF or ICF/IID Residents
When hospices serve patients in a Skilled Nursing Facility/Nursing Facility (SNF/NF) or an Immediate Care Facility (ICF/IID), 418.112(f) holds the hospice responsible for orientation and training of facility staff that will provide care to hospice patients. Furthermore, it states that it’s up to the hospice to determine training frequency. As a result, facilities could be subject to duplicate training when multiple hospices provide services in a single facility. By assigning sole responsibility to hospices, it may also slow down collaboration and training innovations.
To address this issue, CMS is proposing to eliminate the current requirement and add a new requirement at 418.112(c)(10). Under the new requirement, hospices and facilities would carry the responsibility to negotiate training for facility staff.
Proposed Home Health Regulatory Reforms
HHA Requirements for Providing Clinical Record Copies
Under the current HH CoPs, when a patient requests a copy of their clinical record, an HHA must provide a copy at the next home visit or within four business days, whichever comes first. CMS believes “next home visit” may not allow enough time for HHAs to produce and deliver the copy.
Therefore, CMS is proposing to remove the “next home visit” and retain “within four business days.”
Home Health Aide Supervision Requirements
In 484.80(h)(3) of the HHA CoPs, if an aide demonstrates a deficiency in a skill during a supervisory visit, he/she must complete a full competency evaluation to assess skills and uncover other deficiencies not identified during the visit.
To reduce time spent completing competency evaluations and retraining, CMS proposes to eliminate the “completing a full competency evaluation” requirement. It proposes to replace it with a requirement to retrain the aide on the deficient skill(s) and require completion of a competency evaluation related only to that skill(s).
Section 484.50(a)(3) requires verbal and written notice of patient rights and responsibilities, but CMS recognizes that this has proven to be overly burdensome for clinicians.
As a result, CMS is proposing to limit verbal requirements to the mandatory notification requirements outlined in section 1891(a)(1)(E) of the Social Security Act. Therefore, Revised 484.50(c)(7) would require verbal notice of rights/responsibilities related to payments made by Medicare, Medicaid, other federally funded programs, and potential personal financial liabilities.
Proposed Home Health and Hospice Regulatory Reforms: Emergency Preparedness
In September 2016, CMS published the “Medicare and Medicaid Programs; emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers” (81 FR 63860) final rule. This rule established emergency preparedness requirements for Medicare and Medicaid providers and suppliers. The rule requires adequate planning for natural and man-made disasters. Providers are also required to coordinate with Federal, State, tribal, regional, and local emergency officials. Upon further review, CMS believes that parts of this rule should be modified or eliminated to reduce burdens while continuing to maintain essential emergency preparedness requirements.
Emergency Plan Cooperation and Collaboration
Today, providers are required to develop and maintain an emergency preparedness plan that includes a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency officials. This includes documenting efforts to contact officials and, when applicable, participation in collaborative and cooperative planning efforts.
CMS has stated that parts of this requirement are too burdensome for providers. Due to the level of burden, CMS proposes to revise 482.15(a)(4) to eliminate the part about documenting efforts to contact officials and participation in collaborative/cooperative planning efforts. While providers would still be required to include a process for collaboration/cooperation with officials, they wouldn’t be required to document efforts to contact them.
Annual Review of Emergency Program
Today, providers must review emergency programs annually. This includes reviewing emergency plans, policies and procedures, communication plans, and training and testing programs.
To increase flexibility with compliance, CMS is proposing to change this requirement to require a mandatory review every two years.
Annual Emergency Preparedness Training
Currently, providers are required to develop and maintain a training program based on their emergency plans. It must be well-organized training, at least annually, that includes initial training in policies and procedures.
To further reduce provider burden, CMS is proposing a revision to this requirement to move from annual to every two years after initial training. Furthermore, it would require additional training when emergency plans are significantly updated.
Annual Emergency Preparedness Testing
In addition to annual training, providers must test their emergency plan by conducting two testing exercises annually.
For inpatient providers, CMS proposes to expand the types of acceptable exercises, allowing one of the two to be the provider’s choice.
After review, CMS believes that two exercises a year is too burdensome for outpatient providers, including home-based care providers. So, it proposes to require participation in a community-based, full-scale exercise (if available) or that providers conduct an individual, facility-based functional exercise every other year. In the opposite years, CMS proposes that providers conduct a testing exercise of their choice.
Finally, an exercise of choice could be a community-based, full-scale exercise (if available), an individual, facility-based functional exercise, a drill, or a tabletop exercise/workshop with group discussion led by a facilitator.
CMS is accepting public comments on these proposed home health and hospice regulatory reforms. You must submit your comments no later than 5 pm ET on November 19, 2018. When commenting, please refer to file code CMS-3346-P. You can submit comments one of three ways:
- Electronically: Submit to regulations.gov. Follow the “Submit a comment” instructions
- Regular mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3346-P, P.O. Box 8010, Baltimore, MD 21244-1810
- Overnight or express mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3346-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850
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Information contained in this blog is for informational purposes only and is not intended to be, and should not be construed as, legal advice. HEALTHCAREfirst strongly recommends that each agency consult with counsel of its own choosing for legal advice in any of these matters.