Big Changes Ahead with the Patient Rights Portion of CoPs

The new Conditions of Participation (CoPs) are receiving a lot of attention and rightfully so since this is the first update in decades!  Patient rights or Condition 484.50 is greatly impacted with the new CoPs.

There were mixed reactions to the final CMS rule on patient rights.  Many commenters supported the proposed patient rights requirements stating that such requirements will help achieve better health outcomes while others questioned the need for an expanded set of patient rights, and stated that the new requirements would require too many forms or that they are repetitive.  However, according to the response, many changes will be incorporated into the current patient rights process that home health agencies (HHAs) are required to have already.  The stated requirements are not viewed as repetitive in that each standard addresses a distinct aspect of patient rights.

Exploring the Six Standards of Patient Rights

According to Condition 484.50, the patient and representative (if any), have the right to be informed of the patient’s rights in a language and manner the individual understands within a defined period of time.  The HHA must protect and promote the exercise of these rights. The six standards pertain to:

Notice of Rights

According to this rights standard, the patient and the patient’s legal representative (if any) must be given many different types of information during the initial evaluation visit, prior to providing care to the patient.  This information includes a written notice of the patient’s rights and responsibilities under this rule, and the HHA’s transfer and discharge policies.  The written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities.  In addition, contact information for the HHA administrator must be provided in case of complaints.  Also, an OASIS privacy notice must be supplied to all patients for whom the OASIS data is collected.

As part of the process for implementing the notice of rights, the patient’s or legal representative’s signature confirming that he or she has received a copy of the notice of rights and responsibilities must be obtained.  Also, a verbal notice of the patient’s rights and responsibilities in the individual’s primary or preferred language and in a manner the individual understands, free of charge, with the use of a competent interpreter, if necessary, must be provided.  Within four business days of the initial evaluation visit, written notice of the patient’s rights and responsibilities under this rule and the HHA’s transfer and discharge policies as set forth in paragraph (d) of this standard must be supplied to the patient selected representative.  A patient selected representative is a new concept introduced with the revised CoPs.

Exercise of Rights

The exercise of rights entails the courts having the rights to appoint a representative to a patient judged to lack mental capacity.

Rights of the Patient

This is more prescriptive in terms of the detailed level of information that must be provided.  For example, unknown source, which is new, has been added to the type of abuse the HHA staff must look for.  A patient should participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate.  A patient must also be aware of any factors that could impact treatment effectiveness.  All services outlined in the plan of care (updates will be on-ongoing) must be received.  If there are any changes, the HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit.  In addition, the patient must be advised of the contact information for specified organizations in the state the patient resides.  These organizations are:

  • Agency on Aging,
  • Center for Independent Living,
  • Protection and Advocacy Agency,
  • Aging and Disability Resource Center and
  • Quality Improvement Organization.

Finally, per this standard, a patient must be informed of the right to access auxiliary aids and language services as described in the accessibility standard, and how to access these services.

Transfer and Discharge

In this new standard, the patient and representative (if any), have a right to be informed of the HHA’s policies for transfer and discharge.  HHAs are required to provide physical or electronic documents for the patient’s keeping that outline the acceptable reasons for DC or TX.  Any revisions related to plans for the patient’s discharge must be communicated to the patient, the rep, and any caregiver(s).

In this standard, several reasons are outlined regarding transfer or discharge (i.e. necessary for patient’s welfare, patient refuses services).  Before a HHA discharges a patient for cause many steps need to be implemented first (i.e. make efforts to resolve behavioral issues, provide contact information for other organizations that may be able to help).

Investigation of Complaints

The HHA must investigate complaints made by a patient, the patient’s representative (if any), and the patient’s caregivers and family.  The HHA must document the existence of the complaint.  In addition, it must take action to prevent further potential violations, including retaliation, while the complaint is being investigated.  This standard has only been updated to reflect unknown sources of injury, neglect and misappropriation of property.


The final right deals with accessibility.  According to it, information must be provided to patients in plain language and in a manner that is accessible and timely.  It specifically covers persons with disabilities and those with limited English proficiency.

Let Us Help You with The Complexity of CoPs

We just provided you with a high-level overview of the patient rights standard of the new CoPs. These changes alone can be very overwhelming once you dive deeper into the details and the corresponding comments and responses.  However, patient rights cover just one standard of the many upcoming CoPs changes.

We offer several education options to help ensure your staff is ready by the January 2018 CoPs implementation date.  If a high-level overview is just what you or staff needs, we offer a high-level 90-minute CoPs overview available on DVD.  However, if you are looking for a more in-depth education option, we recorded a four-part webinar series, also available on DVD.  Your staff can view it at their convenience.  Finally, for a more interactive approach we can provide onsite training.  If you would like to explore any of these training options further with us, please feel free to contact us at [email protected] or 314-952-8392.

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