Home Health

CMS finalizes discharge rule and clarifies points about aide competency testing

The long-awaited final discharge planning rule, released today, appears to offer some good news for home health agencies. And simultaneously CMS clarifies in a separate rule that pseudo-patients are OK to be used for home health aide competency testing, an issue there has been a lot of questions about.

CMS states in the rule that after considering comments to the proposed rule it has decided not to make any changes to §484.58(a), with the exception of the IMPACT Act requirements. The provisions take effect 60 days after the rule is published in the Federal Register, according to CMS.

Here’s a look at some of the discharge planning changes that CMS finalized in the rule:

  • Revise § 484.58(b)(1). Instead of a specified list, the agency must send necessary medical information pertaining to the patient’s current illness and treatment, post-discharge goals of care and treatment preferences to the receiving facility or health care practitioner to ensure the safe and effective transition of care.
  • Revise § 484.58(b)(2). The agency must comply with requests for additional clinical information made by the receiving facility or health care practitioner. This may include items such as a copy of the patient’s current plan of care or latest physicians’ orders.

CMS first proposed discharge planning changes in October 2015, and then delayed the deadline for release of the final rule to Nov. 3, 2019, because it couldn’t meet the 3-year deadline to finalize the rule.

Due to public comments received and stakeholder feedback, CMS determined “there are significant policy issues that need to be resolved” and there is a need to coordinate with another government agency.

Pseudo-patients OK for aide competency

A separate rule, also released today, clarifies how home health agencies can assess home health aide skill competencies and revises hospice requirements related to medication management. Based on these changes, agencies will again be permitted to use pseudo-patients during aide skill competency assessments.

Below are updates outlined in that rule:

  • Revise §484.80(c)(1) to clarify that skill competencies may be assessed by observing an aide performing the skill with either a patient or pseudo-patient as part of simulation. Pseudo-patient and simulation are defined in §484.2.
  • Revise §484.80(h) related to having to complete a full competency eval when an aide is found to be deficient in one or more skills. Instead of completing a full competency evaluation, an aide would only be required to complete retraining and a competency evaluation directly related to the deficient skills.

In that same rule, CMS called for the following changes:

  • Remove requirements related to having a hospice employ an individual with specialty knowledge of hospice medications.
  • Revises the requirement for hospices to coordinate with SNFs/NFs and ICFs/IIDs for assuring orientation of facility staff.

Editor’s note: View the rules at: https://www.federalregister.gov/public-inspection/current. For continued coverage, see future issues of Home Health Line.