The Revised Conditions of Participation: Why Focusing on Patient Rights is Important

Medical care can be overwhelming and confusing for the average person. I know from my own experiences, I may receive instructions from my physician, ask all the questions I can think of and need to call back with follow up questions or clarification of instructions. Many variables are at play when we have an encounter with a health care provider, such as illness, concern, overload of information, medical jargon and incomplete understanding of the information given.

It is challenging enough to maneuver the healthcare system, but imagine if you spoke a different language than those providing your care! If a patient cannot understand their rights and responsibilities, how can he or she exercise these rights? And, if the patient is trying to exercise these rights, but cannot effectively communicate because of language barriers or physical disability, how can he or she do so? The short answer is they cannot.

New CoPs
New requirements mandate that HHAs notify patients, legal representatives and patient-selected representatives of a patient's rights in a language and manner the individual understands. This process begins at the initial assessment, in advance of furnishing care, and must be completed within four days of the initial evaluation visit, depending on the representatives involved.

Notification of Rights Process

Initial Evaluation Visit Second Visit Within Four Business Days of Initial Evaluation
Notification of rights to patient and legal representative.
(Ex: Medical Power of Attorney, Court-appointed representative when patient lacks legal capacity)
Verbal notification of rights to patient and legal representative in language of choice. Written notice of rights to patient's appointed representative, if patience chooses to have them notified.
(Ex: neighbor, friend; not the Medical Power of Attorney, which is a LEGAL representative type)
In writing Verbal notification In writing
Must be in language and manner the individual understands. Translation services must be free of charge. Patient may decline to have non-legal representative educated on patient rights.
Obtain signature of receipt of rights from patient or legal representative. Documentation must show verbal notification occurred. Documentation must show this occurred or that patient declined educating representative.


The updated CoPs mandate who can exercise the rights of the patient. For example, if the patient has legal mental capacity to make his or her own decisions, he or she should be allowed to do so. However, if the patient has been legally declared to lack mental capacity, his or her rights would be exercised in the manner and by whom the courts have appointed. The HHA needs to obtain legal documents for clarification of the extent a patient can exercise their rights and who is legally appointed to make decisions for the patient before care is initiated.

Changes to Patient Standards
There are six patient rights standards in the updated CoPs: 1) Notice of Rights 2) Exercise of Rights 3) Rights of the Patient 4) Transfer and Discharge 5) Investigation of Complaints and 6) Accessibility.

Other new and changed patient rights include:

  • New standards regarding the patient's right to participate in, be informed about, and consent or refuse care in advance of and during treatment;
  • Timelines regarding notification of changes to the extent of coverage for services;
  • New mandate to advise the patient of five state and federal entities that serve in the patient's coverage area;
  • Notification of the HHA's policies on Transfer and Discharge;
  • Notification of the HHA Administrator's name, business address and phone number in order to make complaints or inquiries regarding the services they are or are not receiving; and
  • Accessibility of websites and auxiliary aides for persons with disabilities

Being able to communicate with the healthcare team and knowing about the patient's rights is an imperative part of delivering quality healthcare. Not understanding the planned care, who to notify if there is a problem, the extent insurance will pay or possible anticipated outcomes, then the patient is unable to self-monitor the journey to better health and communicate obstacles encountered along the way.

The new standards of care ensure that the patient is aware and involved in the delivery of quality care. Putting ourselves in the patient's shoes will help us to realize the importance of understanding and participating in their care delivery. Alleviating stress factors clears the path to desired outcomes for the patient and the home health agency and its professionals.

For detailed information on patient rights related to the revised CoPs, view our complimentary, on-demand CoPs video series.