An Interpretive Guideline for Home Health CoPs

When the conditions for a Home Health Agency (HHA) to participate in Medicare program were released, the agencies weren’t quite sure of the changes that need to be incorporated. These Conditions of Participations (CoPs), which roughly costs $300 million has gone into effect from January 13, 2018.

Though the final version for Interpretive Guidelines is not released, CMS released a draft of the Interpretive Guidelines on the final CoPs for home health agencies providing specifics on all the sections under CoPs, which include:


In regards to releasing patient identifiable OASIS information under Patient care, CMS clarifies that:

The HHA and agent acting on behalf of the HHA in accordance with a written contract must ensure the confidentiality of all patient identifiable information contained in the clinical record, including OASIS data, and may not release patient identifiable OASIS information to the public.

The EHR or any third party vendor that helps HHAs submit OASIS data must develop and implement policies and procedures to protect the security of ePHI they create, maintain, receive and transmit. The confidentiality of the records needs to be maintained with integrity. The transmission should be over a trusted connection. The encoded OASIS data must accurately reflect the patient’s status at the time of assessment which implies the EHRs provide a real-time data that is fed into the system. A dashboard provides a real-time statistics if any assessment data is not completed.

The encoded OASIS data must accurately reflect the patient’s status at the time of assessment.

For the data format, the HHA must encode and transmit data using the software available from CMS or software that conforms to CMS standard electronic record layout, edit specifications, and data dictionary, and that includes the required OASIS data set.

Patient Rights

Besides EHR helping HHAs with tracking of legal representative(s), CMS also clarified that patient should be able to determine the role of the representative, to the extent possible. This can also be accomplished by providing a portal for patients to access the health information where the patient can also give permission to the representative. Portal also helps in tracking the progress of patients and ensure patients receive appropriate notification for notices on their request.

Provide verbal notice of the patient’s rights and responsibilities in the individual’s primary or preferred language and in a manner the individual understands, free of charge, with the use of a competent interpreter if necessary, no later than the completion of the second visit from a skilled professional.

A written notice to the patient or the representative of their rights and responsibilities under this rule should be provided in hard copy unless the patient requests that the document should be provided electronically. In addition, if a patient or his/her representative’s understanding of English is inadequate for the patient’s comprehension of his/her rights and responsibilities, the information must be provided in a language or format familiar to the patient or his/her representative. Also, language assistance should be provided through the use of competent bilingual staff, staff interpreters, contracts, formal arrangements with local organizations providing interpretation, translation services or technology and telephonic interpretation services.

EHRs will need to ensure tracking of all the notices and documentation of those within the application for future reference.

The patient now need to participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to –

  1. Completion of all assessments
  2.  The care to be furnished, based on the comprehensive assessment
  3.  Establishing and revising the plan of care
  4.  The disciplines that will furnish the care
  5.  The frequency of visits
  6.  Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits
  7.  Any factors that could impact treatment effectiveness
  8.  Any changes in the care to be furnished

Care Planning

The CoPs permit any nurse acting in accordance with state licensure requirements to receive verbal orders from a physician and document the orders in the clinical record and date and sign them and record the time. The Draft Interpretive Guidelines do not require that the home health plan of care be submitted to the physician every time a verbal order is received; however, the documentation of the order should be recorded and tracked within an EHR or care coordination platform.

A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status.  The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician-ordered start of care date.

When it comes to comprehensive assessment, each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment and the patient’s eligibility for the Medicare home health benefit including homebound status needs to be provided, both at the time of the initial assessment visit and at the time of the comprehensive assessment.

Completion of the comprehensive assessment should provide the HHA with the overall patient’s status in order to develop the plan of care.  An assessment of the patient’s current health status includes relevant past medical history as well as all active health and medical problems.

The intent of identifying patient strengths is to empower the patient to take an active role in their care.  The HHA asks the patient to recognize her/his own strengths while the HHA also identifies patient strengths to inform the plan of care and to set goals with associated outcomes and the progress is tracked in the application.


The HHA QAPI program includes procedures for and frequency of measurement and analysis of indicators. QAPI contains five standards:

  • Program Scope
  • Program Data
  • Program Activities
  • Performance Improvement Projects
  • Executive Responsibilities
CoPs interpretative guideline clarifies that the agency must develop, implement, evaluate and maintain an effective, ongoing, agency-wide, data-driven QAPI program.

QAPI can be best implemented if they tie up with the current problems that the agency is facing. Based on the problem areas, the agency can select the quality indicators (KPIs) depending on identified adverse or negative patient outcomes or agency processes that the agency wishes to monitor and measure. Another idea is to ensure the loop between process-based OASIS measures and outcome-based measures are coupled. A process measure can lead to an outcome which can be tied up with QAPI. Each indicator must be measurable through data in order to evaluate any agency change in procedure, policy or intervention.

The phase-in date for performance improvement projects is now July 13, 2018; while other QAPI requirements should have already been started from January 13, 2018.

Complete details on CoPs and impact on EHRs can be found here.

The following two tabs change content below.
Vijayalaxmi Kudekar

Vijayalaxmi Kudekar

An explorer who passionately seeks meaningful real-life problems facing the healthcare system and loves to apply technology to create business impact. For a cerebral recharge I prefer books, puzzles or some colors and a paint brush.
Vijayalaxmi Kudekar

Latest posts by Vijayalaxmi Kudekar (see all)

Leave a Reply

Your email address will not be published. Required fields are marked *