CMS Issues Final Rules for Home Health Agencies and Patients’ Rights


Bill is considering bringing in a home health aide to help with his mother, Nancy, who has limited mobility from Parkinson’s disease. He was a little hesitant at first, because he was concerned about quality of care. He has been the one who has been solely caring for her for years, and was worried that she wouldn’t receive the same treatment from a stranger he hires through an agency. Now, for people like Bill and Nancy, there are new rules to ensure that home health care providers meet certain standards for in-home care, and patients have more rights.

Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health care from nearly 12,600 Medicare and Medicaid-participating home health agencies nationwide. Home health care is designed to allow patients to receive needed health care and custodial care services within the comfort and safety of their own homes. Patients receive coordinated services including assistance with activities of daily living, skilled nursing, physical therapy, medical social services, and more — all under the direction of their physician.

This month, the Centers for Medicaid & Medicare Services finalized a rule that sets minimum standards for home health agencies. The rule is aimed at improving the quality of care for Medicare and Medicaid beneficiaries and boosting patients’ rights. According to Kate Goodrich, MD, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality for CMS, “Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies. The announcement was the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholders and medical evidence.”

The 374-page rule sets out conditions for home health agencies to be able to participate in federal Medicare and joint federal-state Medicaid programs. The rule includes requirements in training, competency, and patient rights. The following is included in the final rule:

◾A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.

◾An expanded comprehensive patient assessment requirement that focuses on all aspects of patient wellbeing.

◾A requirement that assures that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform and the name and contact information of a home health agency clinical manager.

◾A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines and that there is active communication between the home health agency and the patient’s physician(s).

◾A requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that continually evaluates and improves agency care for all patients at all times.

◾A new infection prevention and control requirement that focuses on the use of standard infection control practices and patient/caregiver education and teaching.

◾A streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines.

◾An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.

◾Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.

◾New personnel qualifications for home health agency administrators and clinical managers.

“We are revising the home health agency requirements to focus on a patient-centered, data-driven, outcome-oriented process that promotes high quality patient care at all times for all patients,” the final rule says.

Home health agencies must meet these requirements and others laid out in the rule to be eligible to provide services to Medicare and Medicaid beneficiaries. The regulations are set to take effect July 13, 2017.

Choosing a Home Health Care Provider

There are many important factors to consider in choosing the best agency to meet your needs, most important of which is to assess what types of services you or your loved one will need.

When selecting an agency, it is important to ask the appropriate questions during your initial meeting. Below is a list of sample questions:

• How many years has the agency been serving your community?

• Does the agency offer printed material describing its services and costs? (i.e. brochures, flyers)

• Is the agency an approved Medicaid provider?

• Is the agency accredited? In other words, has their quality of care been surveyed and approved by an outside accrediting organization (such as CHAP, JCAHO or Medicare)?

• Will the agency provide a list of references?
• Is the agency licensed by your state (if required)?

• Does the agency provide patients with a “Bill of Rights” that outlines the rights and responsibilities of the agency, patient, and caregiver alike?

• Is there a written plan of care for the patient’s treatment that the patient, physician and family participate in developing?

• Is this plan updated over the course of the treatment?

• Does the patient get a copy of the plan?

• Does the agency staff educate the family members on the care being administered to the patient and ways they can assist?

• Is the patient’s course of treatment documented, detailing the specific tasks to be carried out by each professional? (i.e. medicines, exercises, daily activities)

• Are supervisors assigned to oversee care to ensure that the patient receive quality treatment?

• Are agency caregivers available seven days a week?

• Does the agency have a nursing supervisor on call and available 24 hours a day?

• Does the agency ensure patient confidentiality? How?

• How are agency employees hired and trained?

• Does the agency require criminal record background checks and communicable disease screens for its employees?

• What is the procedure for resolving issues that may arise between the patient/family and home healthcare staff?

• Who can you call with questions or complaints regarding patient care, caretaker issues or general questions?

• What happens if a staff member fails to make a scheduled visit?

• What should the patient do in this situation?

• Who does the agency call if the agency caretaker cannot come when scheduled? (i.e. patient or family member)

• What is the agency caretaker required to do? (i.e. inform patient, reschedule)

If you purchase home healthcare services from an individual rather than through an agency, it is important to screen the individual person(s) providing the scheduled care. Interview the caregiver to be sure he or she is qualified for the job. It is helpful to ask for references, as well as, to have a list of required tasks the caretaker may have to perform with the patient (i.e. getting in and out of a wheelchair, bathing, administering specific types of medicine). This way you know that he or she can indeed perform these tasks. It is also important to have a Caregiver Contract in place. Please see our article on this topic.

When Aging in Place is No Longer an Option

Most people want to stay in their home for as long as possible, with or without the assistance of a home health aide. However, if you or a loved one cannot live independently and are showing signs that living alone is a strain, it may be time to consider other alternatives.

Whether the outcome is assisted living or nursing home care in the future, it is always wise to plan ahead. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Please know that The Law Firm of Evan H. Farr, P.C. is here when you need us — just call to make an appointment for a no-cost initial consultation:

Fairfax Medicaid Asset Protection Attorney: 703-691-1888
Fredericksburg Medicaid Asset Protection Attorney: 540-479-143
Rockville Medicaid Asset Protection Attorney: 301-519-8041
DC Medicaid Asset Protection Attorney: 202-587-2797

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