Home Health & Hospice Week

Latest COVID Relief Package Contains Hits, Misses For Home Health & Hospice

After Congress stalled on passing COVID relief all summer and fall, it passed and the president signed a nearly $900 billion bill into law Dec. 27.

The legislation contains many wide-ranging provisions affecting the nation and overall economy. But it also holds a raft of provisions that will more specifically impact home health and hospice agencies. They include:

• An additional $3 billion in Provider Relief Funds and changed rules for calculating lost revenues (see story, p. 3).
• An additional $280 billion in Paycheck Protection Program funds and relaxed rules for those that may be eligible. “Many home care and hospice companies qualify as ‘small business’ under [Small Business Administration] standards and have taken advantage of the Paycheck Protection Program that began through the CARES Act that was passed in March,” points out the National Association for Home Care & Hospice in its law summary.
  The new law permits a “second draw PPP loan” for “smaller and harder-hit businesses,” note attorneys with law firm Ball Spahr in online legal analysis. It also expands eligible expenses to items such as personal protective equipment (PPE), software, and additional human resources and accounting needs, the Ball Spahr attorneys add.

• A continuation of the moratorium on the 2 percent sequestration cut through March 31. The Centers for Medicare & Medicaid Services confirmed the extended suspension of the adjustment in a Dec. 28 message. “The suspension of the ongoing 2 percent sequestration of Medicare payments will bring an estimated $100 million in relief to hospices and $90 million in relief to home health agencies through the first three months of 2021,” NAHC cheers.
• Numerous hospice survey changes (see story, p. 4).
• An extension from 2025 to 2030 of the IMPACT Act’s provision to calculate the aggregate hospice cap amount based on the hospice payment update, the National Hospice & Palliative Care Organization notes in a release. Currently it’s based on the Consumer Price Index for Urban Consumers (CPI–U), NAHC says.
• By Jan. 1, 2022, Health and Human Services will “permit an occupational therapist to conduct the initial assessment visit and to complete the comprehensive assessment … for home health services … if the home health plan of care … (1) does not initially include skilled nursing care; (2) includes occupational therapy; and (3) includes physical therapy or speech language pathology,” the law says.

Many of these provisions are very welcome. “This legislation will enable hospice providers to continue providing uninterrupted care during this unprecedented time,” NHPCO President Edo Banach says in a release. The sequestration moratorium extension will “enable providers to keep their doors open and offer care to communities in need as COVID-19 infections continue to rise,” he adds.

“The most notable successes in the legislation are the extension of the moratorium on the 2 percent Medicare sequestration cut and the hospice survey provisions that reduced mandatory surveys from every two years to every three years while authorizing more frequent surveys targeted to non-compliant hospices,” judges NAHC President William Dombi in a message to members. “The additional support available through the SBA Paycheck Protection Program will also help many home care and hospice companies.”

However: “While the outcome is positive, there is much to do next year to ensure that home care and hospice can fully operate during the pandemic and beyond,” Dombi cautions.

For example, home health agencies need direct payment for telehealth visits, Dombi tells AAPC. And hospices need payment for respite care at home, not just in facilities, he adds.

All providers would benefit from more PRF funding and a full year of the sequestration 2 percent suspension, Dombi continues.

Stay tuned: Providers may get a second shot at these and other wish list items in another COVID relief package relatively soon, experts predict.

Problems and unintended consequences created by the 5,500-page legislation’s “compressed timeline” combined with “those interest groups that did not receive, in their view, adequate support in this legislation, may create momentum for another relief package early in 2021,” expect attorneys with law firm Arnold & Porter in online legal analysis. “In addition, President-Elect Biden and Democratic leadership in Congress made it clear they consider this package relief for those struggling from the effects of the pandemic, and they hope to pass an economic stimulus package in the first 100 or so days of the Biden Administration.”

Watch for: “That is more likely to happen if Democrats win both Georgia Senate races on January 5 and gain control of the Senate,” the Arnold & Porter lawyers say. “If Republicans win in Georgia and retain narrow control of the Senate, a 2021 relief package would be smaller in scope and may require more time to negotiate.”

Note: Links to the bill text are at www.congress.gov/bill/116th-congress/house-bill/133/text.