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CMS Proposes Revisions to Hospice and Home Health Conditions of Participation


The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule — Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction — to revise several conditions of participation (COP) and conditions for coverage for Medicare and Medicaid providers, including hospice providers and home health agencies. This proposed rule continues the efforts by CMS to reduce the regulatory burden on providers and suppliers by simplifying and streamlining processes, reducing the frequency of activities and revising timelines, and revising and removing obsolete, duplicative, or unnecessary requirements.

For hospice providers, the revisions proposed by CMS include:

  • Removal of the requirement that a State licensure program must meet specific training and competency requirements set out in federal regulations to be deemed an appropriate qualification for hospice aide employment. This would permit hospices to defer to State licensure requirements and would allow states to develop their own training and competency requirements which meet the needs of their respective populations.
  • Deletion of the requirement for a hospice provider to ensure that the interdisciplinary group confers with an individual with education and training in drug management who is an employee of or under contract with the hospice to ensure that drugs and biologicals meet each patient’s needs. CMS noted that this specific requirement was no longer needed due to the proliferation of pharmacy benefit management companies that provide pharmacist services to patients along with the increase in nursing and physician specialists employed by hospice providers.
  • Replacement of the requirement that a hospice provide a paper copy of policies and procedures on the management and disposal of controlled substances with a requirement that information regarding the use, storage, and disposal of controlled substances be provided to the patient or patient representative, and family in a manner that addresses the perspectives and information needs of patients and families.
  • Moving the requirement for facility staff orientation from a stand-alone requirement to the requirement regarding a written agreement between hospices and skilled nursing facilities. This would permit both entities to negotiate the terms for orientation of facility staff, encourage collaboration, and avoid duplication of efforts regarding orientation training.

For home health agencies, CMS proposals include:

  • Removal of the requirement for home health agencies to provide a copy of the clinical record to a patient, upon request, by the next home visit. The requirement that a copy of the clinical records must be provided within 4 business days upon request would be retained.
  • Revising the requirement to complete a full competency evaluation when an aide is found to be deficient in one or more skills to a requirement for retraining and a competency evaluation directly related to the deficient skill or skills.

CMS is seeking to reduce burdens for providers, improve patient care, decrease costs and help improve health care choices by patients and providers. In addition to comment on these proposed rules, CMS is soliciting additional proposals to help reduce the regulatory burden for providers for future rulemaking.

Comments must be received by CMS no later than November 19, 2018 to assure consideration.

Iain Stauffer is a member of the Health Care team at Poyner Spruill. He can be reached at 919.783.2982 or by email at

Physical Address: 301 Fayetteville Street, Suite 1900, Raleigh, NC 27601 | © Poyner Spruill LLP. All rights reserved.

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