Health Law Daily Home health Final rule emphasizes patient rights, quality improvements
Tuesday, January 10, 2017

Home health Final rule emphasizes patient rights, quality improvements

By Kayla R. Bryant, J.D.

Home health agencies (HHAs) will be subject to additional conditions of participation (CoPs) related to ensuring patient wellbeing and protecting patient rights. The new HHA Final rule, scheduled to publish January 13, 2017, creates requirements for better communication with patients and caregivers and among HHA staff, as well as various assessment programs. Additionally, the organizational structure of HHAs is simplified, although parent agencies and branches are still allowed to operate as such. The new regulations are effective July 13, 2017.

CoPs. CMS proposed revision of HHA CoPs in 1997, but only finalized regulations related to the use of the Outcome and Assessment Information Set (OASIS) in 1999 (64 FR 3764) due to the volume of public comments and the changing nature of the industry. This rule implemented a requirement that each patient receive a comprehensive assessment. Other rulemaking delays resulted in no further proposed rules until October 2014 (79 FR 61164) (see Home health CoPs to get first renovation since 1989, October 9, 2014).

Quality of care. The rule notes that CMS’ approach to quality has been to identify providers that fail to meet standards or offer poor quality of care. The agency believes that the enforcement approach has been an expensive way to deal with "marginal providers," and has failed to stimulate improvements in quality on a broad scale. The new regulations shift the focus of home health to a "patient-centered, data-driven, outcome-oriented process." HHAs will be required to provide a significant amount of information to the patient and the patient’s representative or caregiver, when appropriate, including a clear notice of the patient’s rights and specific contact information for the HHA’s administrator in order to report complaints and ask questions about care.

Patient rights. The regulations provide that patients have the explicit rights:

  1. to have property and person treated with respect;
  2. be free from abuse, injuries of unknown source, neglect, and misappropriation of property;
  3. to make complaints;
  4. to participate in, be informed about, consent to or refuse care;
  5. to receive all services outlined in the plan of care;
  6. to confidentiality of clinical records;
  7. be advised of payment liability;
  8. be advised in advance of care that may not be covered, or in advance of on-going care to be reduced or terminated;
  9. be advised of a home health hotline available for complaints;
  10. receive contact information for relevant agencies for consumer information, protection, and advocacy;
  11. be free from discrimination for exercising these rights; and
  12. to be informed of the availability of auxiliary aids and language services.

Assessments and care. The majority of the requirements for providing patient-specific comprehensive assessments were retained, but reorganized. The assessment must accurately reflect the patient status. A new CoP encompassing care planning, coordination services, and quality of care requires that an HHA provide an individualized plan of care, accept a patient with a reasonable expectation that the agency can meet the patient’s needs in the place of residence, revise the plan of care as needed, integrate patient services, and provide training and education to each patient and caregiver where applicable.

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