CMS Conditions of Participation Standards: What You Need to Know


Although it’s been months since the Centers for Medicare & Medicaid Services (CMS) finalized new rules governing home health agencies, there’s still plenty of confusion – and worry – about the home health Conditions of Participation (CoP) standards and what they mean for these agencies.

The CoP standards were released in a bid to improve home health care by creating a more patient-centered focus. It’s the first time they have been updated since 1997, and the changes are significant, says Mary Carr, vice president of Regulatory Affairs for the National Association for Home Care & Hospice. “It’s really sweeping changes. There’s so much that needs to be done and so much is different. There’s no easy way to [become compliant.]”

Diane Link, director of clinical services in Blacktree Healthcare Consulting, a post-acute healthcare consulting firm based in Conshohocken, Penn. says one of the most difficult CoP standard changes relates to patient rights. Under the draft guidelines, patients and their representatives have the right to be informed of and involved in their plan of care. This means that home healthcare providers must not only explain patient rights and get a signature stating that the patient and his or her representative understands those rights, they must also make them part of plan of care decisions.

“CMS is putting a focused approach on the development of the plan of care. No one can go in and say, ‘This is what we’re going to do,’ Now, we’ve got to say, ‘What are the goals of our home visits and how can we partner with you in an interdisciplinary way?’ They’ve got to involve the patient and their family but also maybe a social worker, the doctor, nurses to achieve those goals,” explains Link.

From a compliance standpoint, this means providers will need to have this discussion with the patient within two days of starting the case and have signed copies of the patient’s rights within four days. In addition, the plan of care will now include additional documentation such as who the caregivers are, what a patient’s weaknesses and strengths are, and what his or her overall risk of re-hospitalization is, says Link. Home healthcare providers will also need a copy of any advanced directives.

“You have to look at everything. For example, if the patient is on multiple medications that cause dizziness – as a home healthcare provider – you have to look at how you can reduce the medications,” she says. While these additional pieces of documentation may seem cumbersome, experts agree that they force coordination of care across disciplines and make the patient’s voice louder.

Making the Right Moves

At this point, most agencies should be at least three-quarters of the way compliant with the new CoP regulations, says NAHC’s Carr, even though the final definitive guidelines have not be released. They “should not be too different” than the draft guidelines, she says. Some vendors, including Forcura, are already working to make the transition and ongoing documentation easier for home healthcare agencies. We are working with our clients to build tools and workflows that will help streamline the collection and dissemination of the new compliance data.


“Currently, healthcare is a paper-based industry. That has to change. You can’t be printing and sharing documents with PHI all over it. That’s not the direction we need to go as an industry,” explains Craig Mandeville, the company’s CEO and founder. “Here at Forcura, we’re building a secure delivery platform so that healthcare providers, patients, and anyone tied to a patient have the ability to access and share data and documents electronically.”

Such a solution will also give healthcare agencies the ability to capture signatures electronically and prove a document was delivered and read, while at the same time improving communications between a patient’s disparate healthcare providers.

Blacktree Healthcare Consulting’s Link says having an electronic platform can also help providers share and document required patient and caregiver education. In addition, it gives agencies and surveyors a way to see how they are faring when it comes to process improvements and patient care since – as long as a platform is compatible and can be integrated with other tools – everything is in one place. Choosing the right technology provider is key, though.  

“Electronic delivery platforms should be easy for the field staff to use and get reports out of,” says Link. “If I want to add an OASIS data scrubber to the solution, how hard is it going to be? Can my nurses use it to order supplies from the patient’s home?”

It’s these kinds of benefits that Mandeville says can make what may seem like a daunting task – becoming CoP-compliant – into something positive. “Yes, people can just keep on doing what they were doing and create manual processes to handle the new regulations, but they can also see this as a way to streamline their overall documentation and cut out a lot of extra work that may hinder an agency’s back office. It’s an opportunity to improve all processes across the board.” 

No matter what you do, though, you have to do something.  While organizations that aren’t completely ready for the new CoPs are likely protected from any civil monetary penalties, that doesn’t mean they can sit back and wait for the final definitive guidelines to be released, says the NAHC’s Carr.

“Nothing suggests that there’s going to be a phase in. They just aren’t going to assess monetary penalties. Can you still get put on a fast track for termination? We’re not sure. Will they still require you to do a corrective action? Yes. People need to do whatever they can today to make sure they are compliant.”

Annie Erstling leads strategy and marketing for Forcura. She has experience launching new brands, products and companies in the healthcare, technology, hospitality and consumer products industries on both the corporate and agency side of marketing. Connect with Annie on LinkedIn.

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Topics: CMS Regulatory Guidance

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