Background
The current Conditions of Participation (COPs), 42 CFR Part 484, went into effect in 2018 and have a specific focus for patient-centered, data-driven, outcome-oriented process that promotes high quality patient care for all patients. This focus reflects the following priorities:
- A continuous, integrated care process across all aspects of home health services, based on a patient-centered assessment, care planning, service delivery, and quality assessment and performance improvement.
- A patient-centered, interdisciplinary approach that recognizes the contributions of various skilled professionals and their interactions with each other to meet the patient's needs.
- Stress quality improvements by incorporating an outcome-oriented, data-driven, quality assessment and performance improvement program specific to each Home Health Agency (HHA)
- Safeguard patient rights.
- And improve performance results for HHAs, in terms of achieving needed and desired outcomes for patients and increasing patient satisfaction with services provided.
What does this mean for home health compliance?
These are priority areas of focus for accreditation surveys. According to the CHAP “Top 10 Home Health Deficiencies -2021”1, the areas where the most deficiencies (noncompliance) occurred were related to Subpart B, §484.50 patient rights and Subpart B, §484.60 care planning, coordination of services and quality of care which correlate directly with the priorities as outlined above.
Subpart B §484.50 Patient rights
This section focuses on patient rights notices and policies and is divided into several sections which outline specific requirements the HHA must follow. In brief, HHA must provide a written notice of rights and responsibilities in advance of care (or within 4 days of initiation of care to patient’s selected representative if applicable). The notice must be understandable to those with limited English proficiency and patients with disabilities and written confirmation of receipt is required. This notice must include the HHAs transfer and discharge policies, contact information of the administrator and the OASIS privacy notice.
A court appointed “legal” representative or patient self-selected representative may elect to exercise the patient’s rights. The patient’s rights, in addition to being free from verbal, mental, sexual, and physical abuse, as well as injuries of unknown source, neglect, and property misuse, now require the patient to participate in their care related to care being furnished, disciplines providing care, visit frequency, goals and any changes in care being provided.
Patients must also be provided with written notice relating to change in payment or non-covered services.
Strategies for Compliance:
- The Patient Rights standard has multiple criteria to meet. Review §484.50 in detail and review and update agency policies and procedures to align with the standard.
- Review patient rights and responsibilities to ensure all components are included and provided to the patient
- Develop a process around home health admissions that includes provision of patient rights and notices and key performance indicators
- Perform frequent in services on frequently non-compliant areas related to discharge and transfer notices, and change in payment, non-covered services or visit frequency such as when to use HHCCN, ABN and NOMNC forms.
- Include this area in QAPI program to monitor and improve problem areas
Subpart B, §484.60 Care planning, coordination of services and quality of care
This section focuses on the requirement that each patient have an individualized written plan of care that must include care and services necessary to meet the patient-specific needs, responsible disciplines, measurable outcomes and goals, and patient and caregiver training and training to facilitate timely discharge. Conformance with physician orders, and coordination of care delivery to meet patient needs is also a key focus of this standard.
Patient involvement in their Care Plan is a key provision where the HHA must provide the patient and caregiver a copy of written information which includes the visit schedule and frequency of visits, patient medication schedule and instructions, pertinent instructions and the name and contact details of the HHA clinical manager.
Strategies for Compliance:
- The Care planning, coordination of services and quality of care standard has multiple criteria to meet. Review §484.60 in detail and review and update agency policies and procedures to align with the standard.
- Develop a process around delivering the medication list to patients at SOC and throughout the episode
- Provide education to clinicians regarding a patient-centered, interdisciplinary approach to care plan development and medication profile management
- QAPI auditing to ensure compliance and improvement in areas of deficiency
This is a very brief overview of two of the ten sections of Subpart B: Patient Care where compliance has been difficult. As Part 484 - Home Health Services includes 5 Subparts with several sections each, navigating the COPs can be daunting; future articles will dive deeper into the most difficult to master.
Resources:
1 https://education.chaplinq.org/products/top-10-home-health-deficiencies-2021#tabproduct_tab_contents__1
https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/SurveyCertificationGenInfo/Downloads/QSO18-25-HHA.pdf https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-484?toc=1
https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-00283.pdf
https://education.chaplinq.org/products/top-10-home-health-deficiencies-2021#tabproduct_tab_contents__1 https://www.healthcarefirst.com/breaking-down-cops-patient-rights/
https://www.healthcarefirst.com/cops-infection-care-planning-coordination/