On January 13, 2018, CMS issued a final rule that updated the Medicare Home Health Agency (“HHA”) Conditions of Participations (“CoPs”).  The final rule represents the first major change in the HHA CoPs in nearly 20 years.  CMS previously extended the effective date of the final rule, which went into effect on January 13, 2018.  Because interpretive guidelines have yet to be finalized, for the first year following the effective date, CMS has indicated that it will not impose any Civil Monetary Penalties (“CMPs”) on HHAs taking action to comply with the rules unless the situation presents as an immediate jeopardy.

According to CMS, the requirements focus on the care delivered to patients; they allow HHAs greater flexibility in meeting quality care standards; and they eliminate unnecessary procedural requirements.

Important Changes to the HHA CoPs include:

  • Patient Rights – The new patient rights CoP is divided into six separate standards. New standards include Transfer and Discharge, Investigation of Complaints, and Accessibility.


  • Comprehensive Assessment of Patients – To establish a more complete understanding of the patient’s condition, strengths and limitations, preferences, and risk factors, additional content is required as part of the patient’s comprehensive assessment.


  • Quality Assessment and Performance Improvement (“QAPI”) – The new rules replace 42 CFR § 484.16 (Group of professional personnel) and 42 CFR § 484.52 (Evaluation of the agency’s program) with a single new CoP for QAPI. The new CoP includes five standards: program scope, program data, program activities, performance improvement projects, and executive responsibilities.  Note that to allow six months for the collection of data performance projects have a phased in compliance date of July 13, 2018.


  • Clinical Records – Changes to clinical records include updated clinical record contents, authentication requirements, and retrieval of clinical records.

This list is not exhaustive, but identifies notable changes to the CoPs.  There are a number of additional revisions made by CMS, and it is important that your organization comply with all aspects of the new rule.

Advis has significant experience providing services to HHAs. We work with providers to assess compliance and implement required changes to meet the new standards. For more information on how this CMS Final Rule will affect your organization, or for assistance in implementing required changes, contact Advis or call  708-478-7030.

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