After months of anticipation, CMS last week released the final copy of the Interpretive Guidelines associated with Home Health Agency Conditions of Participation. These guidelines will be incorporated into the State Operations Manual, Appendix B, and are to be used by the surveyors who periodically assess a Medicare-licensed agency for compliance with the CoPs. Agencies found to be non-compliant with Conditions of Participation face hefty fines, as well as inability to bill Medicare, Medicaid or other federal payors for services rendered.

The Interpretive Guidelines continue to emphasize quality of care, patient rights and patient outcomes. Many examples of this are apparent throughout the 78-page document, including the following:

• Requirement to transmit OASIS data at 484.45. This data is used to monitor quality, calculate payment, and measure patient outcomes.
• Notification of patient rights at 484.50. The patient and his or her representatives should be well informed of their rights – including informed consent and right to receive all services on the plan of care – to ensure they have full opportunity to exercise them during the duration of their care
• Patient-specific comprehensive assessment of the patient at 484.55. This includes an accurate, individualized assessment of patient status, eligibility (including homebound status), current health, psychosocial, functional and cognitive status, strength, goals, and care preferences.
• Personalized, up-to-date plans of care at 484.60. The plans of care follow physician’s orders at all times, as well as coordination of care with all physicians involved in the patient’s plan of care.
• Responsibilities of skilled professionals at 484.75. These responsibilities ensure assessment, treatment and coordination of care is patient-based, individualized and ongoing.

Agencies are encouraged to study the newly published Interpretive Guidelines and ensure their agency’s policies and procedures are up-to-date and compliant to avoid deficiencies and fines upon survey. Agencies should remember that the surveyor will assess processes based on the most stringent regulation, whether that be the HHA CoPs, accreditation body regulations or even agency policy. The HHA CoP Interpretive Guidelines can be referenced here.