Home Health & Hospice Week

But that’s not quite the whole story.

Medicare officials have told providers to begin planning for the end of the COVID-19 PHE and many of its related regulatory flexibilities. For home health and hospice agencies, one of the biggest pain points will be losing face-to-face encounters via telehealth.

“Throughout the COVID-19 public health emergency (PHE), [the Centers for Medicare & Medicaid Services] has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 and help keep people safer,” three top CMS officials said in a blog entry posted Aug. 18 (see HCW by AAPC, Vol. XXXI, No. 30). “Many of these waivers and broad flexibilities will terminate at the eventual end of the PHE, as they were intended to address the acute and extraordinary circumstances of a rapidly evolving pandemic and not replace existing requirements,” said Jonathan Blum (CMS Chief Operating Officer and Principal Deputy Administrator), Carol Blackford (Director, Hospital and Ambulatory Policy Group) and Jean Moody-Williams (Deputy Director of the Center for Clinical Standards and Quality).

Then: On March 17, 2020, CMS announced an expansion of telehealth benefits for physicians and their patients under the PHE, and on March 23, 2020, CMS clarified in a COVID-19 Frequently Asked Question set that “under the expansion of telehealth under the 1135 waiver, beneficiaries are able to use telehealth technologies with their doctors and practitioners … for the face-to-face encounter to qualify for Medicare home health care” (see HCW by AAPC, Vol. XXIX, No. 11). CMS confirmed the same for hospice F2F encounters in an interim final rule released March 30 (see HCW by AAPC, Vol. XXIX, No. 12-13). In a number of different guidance documents, CMS made clear early on that F2F encounters with physicians or other qualified non-physician practitioners must include both an audio and visual component.

Now: Those flexibilities will continue until the PHE ends, and the CMS officials reiterate that Health and Human Services Secretary Xavier Becerra “has committed to giving states and the health care community writ large 60 days’ notice before ending the PHE.”

Ahead: But when the PHE ends, so will that specific flexibility. “The face-to-face encounter can be conducted via telehealth irrespective of the COVID-19 PHE,” CMS notes in its “Home Health Agencies: CMS Flexibilities to Fight COVID-19” fact sheet. “However, the waiver only extends the ‘originating site’ to the patient’s home during the duration of the COVID-19 PHE,” the sheet reads. For hospices, CMS simply notes the F2F waiver “will expire at the end of the PHE” in the hospice fact sheet.

In other words, “CMS indicated that the flexibilities currently allowing home health agencies and hospices to utilize telehealth for completion of their respective face-to-face encounter requirements would terminate with the end of the PHE,” notes the National Association for Home Care & Hospice in its member newsletter.

Home health and hospice agencies will have a bit more time to adjust than the fact sheets indicate, however, according to NAHC. The Consolidated Appropriations Act of 2022 contains “provisions that extend the geographic and originating site requirement waivers (Section 301) and the waiver allowing use of telehealth to perform the hospice face-to-face encounter (Section 306) for 151 days following the end of the PHE,” the trade group points out.

CMS officials have acknowledged to NAHC “the changes made by the CAA 2022 and have indicated that they are in the process of correcting the fact sheets to reflect that the home health and hospice F2F telehealth waivers will remain in effect through the 151^st day following the end of the PHE,” NAHC reports. “Home health and hospices should expect to see revisions made to the fact sheets in the near future,” the association adds.

Stay tuned: Pending legislation in Congress could extend those dates if it passes into law, NAHC points out. v

Note: The 13-page home health flexibilities fact sheet is at www.cms.gov/files/document/home-health-agencies-cms-flexibilities-fight-covid-19.pdf and the nine-page hospice flexibilities fact sheet is at www.cms.gov/files/document/hospice-cms-flexibilities-fight-covid-19.pdf.