Federal Regulations

Federal Regulations & Resources

Navigating the complex landscape of federal regulations is essential for ensuring compliance with home care services. These regulations govern various aspects of patient care, workforce standards, and operational practices. Understanding these rules is critical for providers to maintain high standards of care while avoiding potential legal pitfalls. Below, you'll find an overview of key federal regulations that impact home care, helping agencies stay informed and compliant with national standards.

Home Health Agencies: State Operations Manual- Guide to Surveyors

The Centers for Medicare & Medicaid Services (CMS) has updated Appendix B of the State Operations Manual (SOM) for Home Health Agencies (HHAs) to align with recent amendments to the Conditions of Participation (CoPs). The update consolidates the HHA survey protocol and interpretive guidelines into one document, revises regulatory tags, and incorporates stakeholder feedback for clarifications and technical corrections. Several previous memos are now obsolete and will be superseded by this new guidance.

CMS.GOV

Conditions of Participation for Home Health Agencies

This final rule revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. These changes are an integral part of our overall effort to achieve broad-based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers.

Federal Register

Home Health Quality Measures

The Home Health Quality Reporting Program (HH QRP) uses three types of quality measures: outcome measures, process measures, and patient-reported outcome measures. Outcome measures evaluate patient health results, process measures assess adherence to evidence-based care processes, and patient-reported outcome measures are based on patient feedback through the HHCAHPS survey. Data for these measures are collected from sources like the Outcome and Assessment Information Set (OASIS), Medicare claims, and the HHCAHPS survey, and are used to calculate and publicly report performance, with some measures being risk-adjusted to account for patient differences.

CMS.GOV

Medicare Home Health & Hospice Rates

Medicare Manuals

Medicare pays for care in a beneficiary’s home when qualifying criteria are met and documented. It is essential for home health agencies to have a complete understanding of these criteria, as you have the right and responsibility, in collaboration with the physician, to decide if the beneficiary qualifies for your services. The agency then must understand what services are covered and how to document these services.

Medicare Payment Models

The 2024 Home Health Final Rule

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1 issued its calendar year (CY) 2024 final rule for the home health (HH) prospective payment system (PPS). New policies will generally be effective Jan. 1, 2024. Overall, CMS provided a 0.8% payment increase, a net payment of $140 million, which is a sharp reversal of the 2.2% aggregate cut proposed in June. The 0.8% increase does not take into account the additional cuts planned by CMS. In the Final Rule, the federal agency also finalized deep rate cuts, including a 2.89% permanent prospective payment adjustment decrease. This is on top of the 3.95% permanent rate cut put in place in 2023.

OASIS

The Outcome and Assessment Information Set (OASIS) is a group of standard data elements home health agencies (HHAs) integrate into their comprehensive assessment, to collect and report quality data to the Centers for Medicare & Medicaid Services (CMS).

Related Resources

Home Health Quality Reporting

Improving quality performance in home health is an increasingly high priority. In 2003 CMS mandated that Medicare-certified Home Health Agencies provide performance data for a variety of quality indicators, which became the basis of the publicly-available Home Health Compare database.

Relevant Resources

Medicare Contracted Quality Improvement Organization-QIO

A Quality Improvement Organization (QIO) is a group of health quality experts, clinicians, and consumers organized to improve the quality of care delivered to people with Medicare.

Acentra Health is the Medicare Contractor for Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Region 1 which includes MA.

As a BFCC-QIO, Acentra Health helps people who are on Medicare - and their families and caregivers - to file quality of care complaints and hospital discharge and skilled service termination appeals. They also offer Immediate Advocacy services to quickly resolve medical concerns.

https://www.acentraqio.com/

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