2.

3.

a. The Medicare conditions of participation for home health agencies shall apply to all agencies defined as home care under this Act, except as noted under Section IV CI below.

b.

The following additional Conditions of Participation shall apply to all agencies, programs or services defined as home care under this Act, unless otherwise noted.

All agencies, programs and services identified in this Act shall have in writing the services to be provided and the schedule for providing these services to the beneficiary.

All agencies, programs and services identified under this Act shall have the means to identify any additional service needs of beneficiaries beyond those they provide; make referrals; and coordinate with other agencies, programs and services providing services to the beneficiary.

Training and Evaluation

a.

b.

C.

All persons providing services as identified under the provisions of this Act shall be trained.

1) The Secretary shall determine the amount and content of the training.

2) Agencies, programs and services providing home care services as identified under the provisions of this Act shall disclose to beneficiaries the amount of training and/or level of certification achieved by the individual worker.

Supervision, as determined by the Secretary, shall be provided for all workers providing services as identified under this Act.

The annual evaluation of the home care agency, program and service shall provide for and document consumer involvement.

1.

Home health services as identified under this Act, excluding agencies that are exclusively durable medical equipment agencies, programs or services, shall have client care processes (provided directly or under contract) which include the following.

a.

b.

C.

d.

A

mechanism for identifying beneficiaries for which a comprehensive service assessment is indicated;

Client assessment appropriate to the service provided to identify and monitor needs;

A plan of care which states reasonable and measurable client objectives and services to be provided to meet the objectives;

A plan of care that employs outcome measures care insofar as they are appropriate and available for each client served;

C.

D.

E.

2.

e.

A method for periodic review of client needs and the plan of care; and a statement of criteria and procedures for discharge and/or transfer to another agency, program or service.

If the agency, program or service uses durable medical equipment in the provision of service, written procedures for the use of equipment in the provision of home health services shall be available, including: provisions for client, family and staff instruction in the correct and safe use of equipment; and provisions for an emergency plan appropriate to the service provided.

Home Help Providers

1.

2.

Agencies, programs or services identified as "home help" under this
Act shall comply with 42 USCS 1395x(m) and (oX4X5X6X7) regarding
state licensing, agency plans and budgets and shall be exempted from
42 USCS 1395x(m) and (oX1X2X3) regarding home health practices,
physician supervision and patient records.

Agencies, programs or services identified as "home help" under this
Act shall have in place:

a.

b.

Written agency policies covering the description of services provided, the conditions for admission, continuing services of clients, and discharge.

Records maintained of services provided to each client.

Modification of Conditions

1.

The Secretary shall have the discretion to modify the Conditions of Participation to meet the circumstances of providers operating on an individual and independent basis except that compliance will be required with the training and the bill of rights provisions on this Act.

Deemed Status

1.

The Secretary shall develop policies and procedures to permit "deemed status" for home care providers who are licensed or certified by states or by accrediting bodies whose standards are at least equivalent to the conditions for participation under this Act.

Section V: Quality Assurance Systems

A.

B.

The Secretary shall ensure that states use the administrative authority granted them under Medicaid, the Social Services Block Grant Program and the Older Americans Act to ensure compliance with the conditions of participation established in this Act and to ensure the quality of services provided.

Monitoring Activities

1. Home Health Agencies, Programs and Services

a. DHHS and its contract Peer Review Organizations (PROs) shall provide quality assurance monitoring of all home health agencies, programs and services receiving reimbursement through Medicare and Medicaid. This monitoring activity is to be implemented no later than one year after the enactment of this Act.

b.

C.

d.

e.

The administration and evaluation of home health quality assurance monitoring shall be the responsibility of the Health Care Financing Administration.

DHHS shall award, administer and evaluate its PRO contract under the stipulation that at least one-half of the PRO's level of effort is for the purpose of quality assurance.

DHHS shall take into consideration information on PRO performance contained in reports issued by the Consumer Advisory Boards (Section VB3) in the renewal of PRO contracts.

DHHS shall be required to make available to PROs such data as is necessary to carry out its role.

3.

4.

a. The Secretary shall require that each state, as a condition of participation, shall have in place a system by which home help agencies, programs and services identified under this Act are monitored for compliance with the quality assurance standards set forth in this Act (hereafter referred to as home help "monitoring agents").

b.

C.

d.

The federal administration and evaluation of the home help quality assurance monitoring system shall be the responsibility of the Secretary.

The state shall take into consideration information on the performance of monitoring agents contained in reports issued by the Consumer Advisory Boards (Section VB3) in the renewal of monitoring agent contracts.

Such data shall be made available to the monitoring agent(s) as is necessary to carry out this role.

Consumer Advisory Boards

a.

b.

C.

d.

e.

Each state or jurisdiction shall be required to have a Consumer
Advisory Board (CAB) within one year of enactment of this
Act. If a state fails to act, the Secretary shall establish the
CAB.

The CAB shall oversee the quality assurance review activities of the PROS and the state designated agents for the review of home help quality by providing input into the awarding of monitoring contracts, evaluating the contracts of the PROS and the mechanisms established to monitor home help agencies, programs and services.

The CAB is to consist of 5-7 volunteer members representative of organizations representing beneficiaries appointed by the chief executive officer of each state or jurisdiction covered by the provisions of this Act. Limited staff support for the CAB shall be provided by the PRO and the home help monitoring agent as is necessary to carry out its functions.

The CAB is not to be involved in the day-to-day operations of the PRO or the home help monitoring agent. It shall not have access to the PROs or home help monitoring agent's review information on either individual beneficiaries or individual health care providers.

The CAB is required to prepare an annual report on October I of each year on the performance of the PRO and the home help monitoring agent to be submitted to the chief executive officer of the state or jurisdiction and the Secretary. The information is required to be used in decisions to award and renew PRO and home help quality monitoring agent contracts.

Monitoring of All Home Care Agencies

a. The Secretary shall encourage the development of coordinated quality assurance monitoring mechanisms for home care agencies that provide both home health and home help services.

b.

C.

d.

e.

Quality assurance monitoring of the agencies, programs and services identified in this Act shall include face-to-face contact with a sample of beneficiaries or their representatives served by the agency, as determined by the Secretary. The sample shall include both active and closed cases.

The Secretary shall develop quality assurance methods for monitoring episodes of client illness and care within and across care settings.

The Secretary shall develop client outcome criteria for use in determining quality assurance in home care.

PROS and home help monitoring agents shall assist in the resolution of quality related problems.

5.

6.

f.

The Secretary shall encourage states and local jurisdictions to develop ombudsman programs comparable to the provisions of Section XIII of this Act for non-elderly beneficiaries under federal, state and local assistance programs as well as those under private pay.

Hot-lines

a. PROS and home help monitoring agents shall each have and make available statewide toll free hot-lines for receiving questions and complaints from consumers, providers and interested parties concerning home care quality issues.

b.

C.

The State Nursing Home Facilities and Home Care Ombudsman shall also operate statewide toll free hot-lines as provided under Section XIII A4.

The CAB shall have access to the information received from the hot-lines as long as it does not identify individual beneficiaries or individual home care providers.

Consumer Education

a. The CAB, PROs and home help monitoring agents shall be responsible for educating home care beneficiaries on quality assurance and on the availability of assistance to respond to quality issues

Section VI: Sanctions

A.

B.

The Secretary shall have or establish policies and procedures, as a condition of funding under Medicare, by which sanctions, including intermediate sanctions, can be imposed on agencies, programs and services out of compliance with the provisions of this Act.

1.

2.

The sanctions available shall be both administrative and judicial, and shall include civil and criminal penalties.

The policies and procedures shall provide for public disclosure of major quality violations and the sanctions imposed.

The Secretary, as a condition of funding under Medicaid, the Social Services Block Grant and the Older Americans Act, shall ensure that states and local jurisdictions have sanctions, including intermediate sanctions, that are available and adequate to address quality violations.

1.

2.

The sanctions available shall be both administrative and judicial, and shall include civil and criminal penalties.

Provisions shall be made for public disclosure of major quality violations and the sanctions imposed.

Section VII: Development of Licensing and Certification Policies

A.

The Secretary shall encourage states to develop policies and procedures for the licensure and certification of home care agencies, programs and services.

1.

The Secretary shall gather and publish state licensure and certification activities for home care agencies programs and services within two years of enactment of this Act. This report shall be updated on a biannual basis.

Section VIII: Homecare Quality Assurance Council

A.

The Secretary shall implement all provisions of this Act in consultation with a standing policy council comprised of persons having expertise in geriatrics, gerontology, rehabilitative practice and supportive services representing home care providers, third party payors, physicians, nurses, social workers, discharge planners, State and Area Agencies on Aging, Veterans Administration representatives, state ombudsmen, PROS, consumers, and representatives of organizations representing beneficiaries.

Section IX: Training and Certification Grants

A.

The Secretary shall provide grants for training programs for home care personnel and caregivers.

1.

2.

3.

Special consideration shall be given to:

a. The training of paraprofessionals, including homemakers, home health aides, personal care attendants and family caregivers;

b.

C.

d.

The training of minority and ethnic group home care personnel; Training programs for high technology services provided in the home and for programs that assist paraprofessionals adapt their services to high technology therapies provided to home care beneficiaries;

The Training of home care personnel to work with minority and ethnic beneficiaries.

Training materials shall be made available to states and home care agencies, programs and services.

The Secretary shall encourage states to work with educational institutions, especially those with a demonstrated expertise in gerontology and geriatrics, to provide training for home care personnel.

Section X: Research and Demonstrations

A.

B.

The Secretary shall establish guidelines and fund studies on quality assurance measures for home care. These studies shall include the following.

1.

2.

3.

4.

5.

6.

7.

8.

Methodologies which develop and evaluate outcome standards in the provision of home care services.

Mechanisms for ensuring and monitoring quality by episodes of care.

Mechanisms for ensuring and monitoring the quality of care provided by small agencies and independent contractors, including waivers of any programs covered under Medicare, Medicaid, the Social Services Block Grant, and the Older Americans Act.

Role and importance of case management for ensuring quality in provision of home care services.

Evaluation of the differing approaches to and responsibility for the development of a plan of care.

Effectiveness and efficiency of the use of "deemed status" to determine and monitor home care quality assurance standards.

Determination of home care agencies, programs and/or services that should meet federal and/or state conditions of participation and which should be exempt from some or all of the conditions.

Evaluation of quality assurance provisions in contract biding processes at the state and local levels.

The Secretary shall establish guidelines and fund demonstration projects focusing on home care. These projects shall include the following.

1. The Secretary shall explore the feasibility of developing certification requirements for homemakers, home health aides and personal care attendants providing services under Medicaid, the Social Services Block Grant Program and the Older Americans Act.

Expansion of PRO's composition and responsibility to include home help services;