Home Health & Hospice Week

Watch out: 2 years is a long time for your staff to have gotten used to lax ways.

With the COVID-19 public health emergency’s end in sight, wise home health and hospice agencies should heed these tips from the experts to unwind pertinent PHE-era policies and practices:

1. Start immediately. “Providers who are still relying upon waivers need to start acting now,” urges attorney Robert Markette Jr. with Hall Render in Indianapolis. Agencies’ most important task, “especially now that we have a deadline, is to get moving,” Markette stresses.

“Once the PHE ends, unless otherwise noted, the waivers end,” Markette explains. “Providers need to be back to pre-PHE operations by May 11. If you are surveyed on May 12 and not back to ‘the old ways,’ you will almost certainly be cited,” he warns.

“Providers have a little over three months,” Markette points out. “They should be using that time wisely. This will allow a planned, controlled rollout of new policies,” which are actually “the old pre-PHE policies.”

Bottom line: “We all remember the chaos around the waivers in 2020,” Markette recalls. “We can avoid that now, because we have ample warning,” he says.

2. ID affected policies. The first order of business is to identify those policies that your agency changed due to PHE waivers, so you can assess whether you will need to change them back — or transition to a new policy.

“As the PHE ends … flexibilities will go away and we will have to return to operating under the [Medicare Conditions of Participation] as written,” Markette observes. Some providers have already transitioned back to their old policies, either because their state PHE ended and their licensure required it, or because they simply no longer needed the leeway and were eager to make their transition to a post-PHE environment smoother.

“Indiana is a prime example” of the former, Markette tells AAPC. “We are a licensure state. At the beginning of the pandemic, the state moved to waive certain licensure requirements. When the state ended the PHE last year, all of the state license waivers went away. This meant providers had to return to following state licensure requirements without the waivers. At that point, the CMS waivers did not matter,” he relates.

Yet other agencies never changed their policies to begin with, and now don’t have to switch back.

3. Narrow down expiring waivers. Once you’ve identified policies you revised for the PHE, check to see whether the changes were made permanent or extended either via legislation or Medicare rulemaking. Those include telehealth flexibilities and the expansion of clinicians allowed to order home health services, for example (see stories, pp. 36 & 37, for others).

4. Move forward with your transition plan. When you have your final list of policies that need to revert to pre-PHE rules, it’s time to draw up a plan for doing so.

While the agency administrator is ultimately responsible for securing changes, a plan should designate who is in charge of the individual policy changes and deadlines for those to take place. Providers can use pre-PHE policies to guide them when needed, Markette suggests.

The plan also needs to set clear deadlines. “Make sure everyone involved understands that the deadline is a concrete deadline set by law,” Markette stresses.

5. Train staff. Begin educating staff on the new policies, making sure to shoot for compliance before the PHE expires, Markette recommends.

Keep in mind: Your staff have had two years to get into the habit of waiver-allowed policies. It may take time to get them compliant with the old CoP requirements, especially when they add burden.

6. Audit. Audit to verify compliance with post-PHE procedures, then provide followup training based on the errors found, Markette advises. That training can be for all affected staff or focus on individuals, based on the pattern of errors detected.

7. Educate patients. Meanwhile, your visiting staff may want to let patients and their families know that free vaccinations, testing, and treatment are coming to an end on May 11, offers healthcare attorney Elizabeth Hogue. Patients can catch up on any missed vaccinations, etc., if they wish before the PHE expires.

8. Boost infection protocol. “It seems likely that field staff members will encounter more patients and family members whose vaccinations are not up to date and who may have symptoms but have not been tested,” Hogue tells AAPC. “Field staff members should be more vigilant about their safety after the pandemic officially ends,” she recommends.

Urgent: “Providers should not wait until the last minute to undo PHE processes,” urge attorneys Gary A. Rosenberg and Victoria Larson with law firm Verrill. “Post-PHE operations will lack many of the waivers and flexibilities providers have grown accustomed to during the pandemic,” Rosenberg and Larson say in online analysis. “To avoid fraud violations, providers will need to be prepared to adapt their practices,” they stress.