CMS has finalized extensive changes to the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in the Medicare and Medicaid programs. The rule is intended to provide HHAs with enhanced flexibility while focusing on “a patient-centered, data-driven, outcome-oriented process that promotes high quality patient care at all times for all patients.”  CMS is finalizing new CoPs on patient rights; quality assessment and performance improvement; infection protection and control; and care planning, coordination of services, and quality of care.  The care planning CoP includes a new requirement that the HHA must provide written instructions to the patient and care giver outlining the visit schedule, medication and patient care instructions, and treatments administered and providing HHA contact information.  CMS also is, among many other things, streamlining a number of current COPs, establishing various new personnel requirements, and revising written notice requirements.  CMS estimates that the final rule will increase costs to HHAs by $293.3 million in year one and $290.1 million annually thereafter; the largest costs result from new information collection requirements (particularly the written instructions to patients and care givers) and notification of patient rights.