Home Health & Hospice Week

But what does your state say?

Some big COVID-19 Public Health Emergency flexibilities have already been made permanent in home health, but a few more are set to join the list.

No. 1: “We propose that HHAs be permitted to use interactive telecommunications systems for purposes of aide supervision, on occasion, not to exceed 2 virtual supervisory assessments per HHA in a 60-day period,” the Centers for Medicare & Medicaid Services says in its home health payment proposed rule for 2022. “We are proposing the define interactive telecommunications systems as multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner,” CMS adds.

Caveat: “While we are proposing to allow this flexibility, we expect that in most instances, the HHAs would plan to conduct the 14-day supervisory assessment during an on-site, in person visit, and that the HHA would use interactive telecom­munications systems option only for unplanned occurrences” such as “a severe weather occurrence, a patient requests to change the date of the scheduled visit, or unexpected staff illness or absence on the planned day for the visit,” CMS says in the rule published in the July 7 Federal Register.

This isn’t a shocker, says consultant J’non Griffin, owner of Home Health Solutions in Carbon Hill, Alabama. “Telecommunications we already knew would probably stay in. The agencies that adopted this during COVID see the benefits,” Griffin tells AAPC. “Unfortunately, not sure how widespread this will be until reimbursement comes with it,” she adds. “Agencies see this as an unneeded cost.”

No. 2: “We propose to maintain … that the registered nurse must make a visit in person every 60 days” to patients not receiving skilled care to assess home health aide care. But CMS wants to “remove the requirement that the RN must directly observe the aide in person during those visits.”

The problem: “This requirement is overly burdensome for the patient and the HHA if multiple home health aides provide care to the same patient,” CMS has heard from providers. “For instance, if a patient has three different home health aides providing care, the nurse is currently required to observe and assess each of the three home health aides while the aide is giving care to the patient. “This circumstance would entail three separate nursing supervision visits on the same patient every 60 days” which “may be onerous on the patient and the HHA,” CMS says in the rule.

The solution: “These proposed revisions from an on-site (direct) observation of each aide while performing care to an indirect supervision visit to assess the adequacy of the aide care plan, the patient’s perception of services provided, and hear any concerns from the patient; may better support the patients’ needs,” CMS asserts.

Plus: CMS proposes to add a requirement that “the RN … make a semiannual on-site visit to the location where a patient is receiving care in order to directly observe and assess each home health aide while he or she is performing care. This semi-annual in-person assessment would occur twice yearly for each aide, regardless of the number of patients cared for by that aide,” according to the rule.

Griffin says she is “surprised that the aide supervision would be documented to stay in place after COVID.”

However, Joe Osentoski with Gateway Home Health Coding & Consulting in Madison Heights, Michigan, seems the aide supervision changes “minor.”

CMS “already made the biggest change,” Osentoski maintains — “the allowance of non-physicians to certify care (as allowed by states).”

Reminder: One of the many clauses in the Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into law March 27, 2020, broadens home health ordering under Medicare. The law amends Section 1814(a) of the Social Security Act (42 U.S.C.1395f(a)) to add nurse practitioners, clinical nurse specialists, and physician assistants to the list of clinicians who can order home health. In a COVID-19 interim final rule released April 30, 2020, CMS implemented the change in regulation and made it retroactive to March 1 (see HCW by AAPC, Vol. XXIX, No. 17).

In fact, none of Medicare’s regulatory flexibilities’ permanence will matter if states don’t go along, highlights attorney Robert Markette Jr. with Hall Render in Indianapolis. The revisions “won’t mean much if states that license don’t mirror these changes,” he says. “Agencies will need to continue to follow state law requirements for aide supervision, etc.”

HHAs and their trade groups would be wise to work with states on these changes ASAP, so they can take advantage of the continued flexibilities, Markette suggests.