CMS revising portions of CoPs

CMS says it’s OK to use mannequins for home health aide evaluations, finalizes other CoPs revisions

The Centers for Medicare and Medicaid Services (CMS) says it never intended for new Conditions of Participation to prevent home care providers from using pseudo patients such as mannequins to train and evaluate home health aides, and it is taking steps to clear up departure from longstanding policy.

The measure is one of many set out Sept. 26 in a final rule which will bring about numerous changes to the new Conditions of Participations implemented in January 2018.

CMS says it will revise language in the CoPs at §484.80 to describe the process for conducting home health aide competency evaluations in a manner that aligns with CMS policy dating back to a 1991 final rule.

“This clarification from CMS regarding the use of mannequins and pseudo patients for home health aides was included in a final rule which will delete a few of the current home health CoPs requirements and revise some others, “ said J’non Griffin, Owner and President of Home Health Solutions.

The revisions are part of a CMS effort to comply with a 2017 Executive Order and the Patients Over Paperwork Initiative targeting regulations believed to be unnecessary, obsolete or excessively burdensome to health care providers. “With these changes, CMS is targeting requirements that impede quality patient care or that divert resources away from furnishing high quality patient care,” J’non said.

What’s in the rule

Home health providers will be affected by several changes within the rule, which eliminates or revises requirements for all sectors of the health care industry.

In addition to clarifying at § 484.80(c)(1) that it is acceptable to make skills competency assessments of home health aides through the use of either a real patient or a pseudo patient as part of a simulation, the final rule also:

· Defines the terms “pseudo-patient” and “simulation” at § 484.2.

· Eliminates the requirement for full competency evaluation set out at § 484.80(h)(3). The eliminated requirement will be replaced with a new requirement for agencies to retrain an aide regarding any identified deficient skill and require the aide to complete a competency evaluation related only to the deficient skills.

· Deletes a CoPs requirement at § 484.50(a)(3) that home health agencies must provide verbal notification of all patient rights.

· Revises a requirement at § 484.50(c)(7) that home health agencies must verbally discuss home health payment and patient financial liability information with each patient.

“We’re reading through the final rule now, and we’ll have more information about these and other important changes and their impact on agencies soon,” J’non said.

Nice try, but…

“During the comment period for these proposed changes, many commenters also suggested that while CMS was looking for ways to reduce the burden on home care providers, it should also consider addressing the face-to-face encounter and homebound requirement,” J’non said.

“However, CMS said they would only consider comments specific to the new CoPs. Those comments about the F2F and homebound requirement were determined to be outside the scope of this rule because they pertain to HHA payment policies.”

Use of pseudo patients

CMS reiterated in the final rule that its policy, established in 1991, remains that home health and hospice agencies may conduct aide training with a mannequin and that it is acceptable to conduct competency evaluations in a laboratory setting using ‘pseudo patients’ such as another aide or volunteer.

According to the final rule, the terms “pseudo patient” and “simulation” will be re-defined to meet the following definitions: Pseudo patient definition: “Pseudo patient means a person trained to participate in a role-play situation, or a computer-based mannequin device. A pseudo-patient must be capable of responding to and interacting with the home health aide trainee and must demonstrate the general characteristic to the primary patient population served by the HHA in key areas such as age, frailty, functional status, and cognitive status.”

Simulation definition: “Simulation means a training and assessment technique that mimics the reality of the homecare environment, including environmental distractions and constraints that evoke or replicate substantial aspects of the real world in a fully interactive fashion, in order to teach and assess proficiency in performing skills, and to promote decision making and critical thinking.”