CMS Finalizes New Medicare and Medicaid Home Health Care Rules and Beneficiary Protections

Home health care allows patients to receive needed health care services within the comfort and safety of their own homes. Patients receive coordinated services ranging from skilled nursing to physical therapy to medical social services, all under the direction of their physician. 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.

“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,” said Kate Goodrich, MD, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality for CMS. “Today’s announcement is 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.”

These changes are an integral part of CMS’ overall effort to improve the quality of care furnished through the Medicare and Medicaid programs, while streamlining requirements for providers. The final rule includes: 

  • 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.

The final rule can be viewed at the Federal Register website at: https://www.federalregister.gov/public-inspection/current

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