Two dates must be kept separate in CMS’s home-health rule published January 13, 2017. The final document scheduled general effectiveness for July 13, 2017. Its performance-improvement-project provision instead begins January 13, 2018. This January 15 retrospective concerns that Friday publication and the schedule stated then, not later implementation history. [2017-00283]

The rule revises conditions that home-health agencies must meet to participate in Medicare and Medicaid. One mechanism is clinical management: qualified individuals oversee patient services and personnel, including assignments, referrals, continuing needs assessments and individualized care plans. A participation condition specifies an agency obligation. It is not a measurement showing that a particular patient received better care. [2017-00283]

The October 9, 2014 proposal explains the earlier design. CMS proposed a clinical manager who would oversee services delivered directly or under arrangement and would be a qualified licensed physician or registered nurse. The final list also includes physical therapists, speech-language pathologists, occupational therapists, audiologists and social workers. The proposal’s narrower qualification rule therefore cannot stand in for the adopted text. [2017-00283][2014-23895]

CMS described an interdisciplinary approach with greater procedural flexibility while retaining quality-care standards. Those are design choices and stated aims. The proposal and final rule belong to one rulemaking chain, not two independent outcome studies. Reading the duties, qualifications and dates together gives a more precise account than saying that all home-care providers faced identical new requirements immediately. [2017-00283][2014-23895]

Source documents

  1. Medicare and Medicaid Program: Conditions of Participation for Home Health Agencieshttps://www.govinfo.gov/content/pkg/FR-2017-01-13/html/2017-00283.htm
  2. Medicare and Medicaid Program: Conditions of Participation for Home Health Agencieshttps://www.govinfo.gov/content/pkg/FR-2014-10-09/html/2014-23895.htm