New Medicare & Medicaid Rules and Protections


Posted on March 15, 2017


This past January, the Centers for Medicare & Medicaid Services (CMS) finalized new Medicare and Medicaid Home Health Care Rules and Beneficiary Protections.  These rules are the minimum health and safety standards that a home health agency must meet to participate in the Medicare and Medicaid programs. The changes in the regulations focus on the quality of care and strengthen patient rights. The agency will be working towards updating policies and procedures and agency activities to comply with these new regulations. The final rule includes:

  • A comprehensive patient rights condition that details the patient and the patient representative are informed of their rights to receive:
    • A written visit schedule with frequency, medications, treatments and contact information for the case manager
    • Written notice of transfer and discharge
    • Administrators Contact information
    • Community resources
    • Complaint policy
  • A comprehensive assessment of patient’s requirement that focuses on all aspects of the patient’s health and patient-centered care
  • A Care Planning, Coordination of Services and Quality of Care requirement that includes:
    • Patient-specific measurable outcomes
    • Assessment of re-hospitalization risk
    • Notification of patient, patient’s representative, and physician with changes in plans of care
    • Providing an integrated team approach to patient care
    • Clinical Manager provides oversight to all care and personnel
  • Infection Prevention and Control requirement
    • Following best practices for prevention
    • Maintain an agency-wide program
    • Provide education to staff, patients, and caregivers
  • Skilled Professional Requirement
    • Interdisciplinary team approach
    • Active participation of all disciplines
    • Participation of patient, patient representative, and caregiver in plans of care
    • Clinical Manager responsible for interdisciplinary care
  • Quality Assessment and Performance Improvement requirement
    • Individualized to the agency
    • Designed to improve patient care/outcomes
    • Capable of showing measurable improvement
    • Focus on high-risk or high volume or problem prone areas
    • Governing Body is responsible for monitoring program
  • Home Health Aide Requirement
    • Focus on competency and performance
    • Training on communication skills

For additional details, please see the full press release, CMS Finalizes New Medicare and Medicaid Home Health Care Rules and Beneficiary Protections.