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Home Health & Hospice Week

Regulations:

Check Which Vital Home Health Flexibilities Will Disappear — And Which Won’t — With The PHE

Published on Fri Feb 03, 2023

Tip: Tighten up those OASIS completion and submission time frames.

The past two years have been a blur of COVID-sparked regulatory waivers, legislative changes, compliance rewrites — and rewrites of the rewrites. If you’ve lost track of exactly which flexibility is expiring when, you’re not alone.

But the Centers for Medicare & Medicaid Services is here to help with a list of “CMS Flexibilities to Fight COVID-19” for each provider type, including home health agencies, updated as of Feb. 1. And the list includes when each flexibility will expire in light of the public health emergency’s newly announced May 11 sunset date.

A 13-page document indicates these home health flexibilities will stick around in some form:

  • Telehealth. “The face-to-face encounter can be conducted via telehealth irrespective of the COVID-19 PHE,” CMS says. Further, HHAs “can provide more services to beneficiaries using telecommunications technology within the 30-day period of care, as long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care,” CMS details. “This provision is permanent beyond the COVID-19 PHE.”

And while the home health-specific sheet doesn’t mention physician telehealth policies, the Consolidated Appropriations Act, 2023, signed into law in December makes sure physicians will continue to get paid under their fee schedule for telehealth visits under current flexibilities extended through December 2024.

  • Homebound. It appears nothing will change when it comes to homebound status and COVID. “A beneficiary is considered homebound when their physician advises them not to leave the home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contract COVID-19,” CMS clarifies. “As a result, if a beneficiary is homebound due to COVID-19 and needs skilled services, an HHA can provide those services under the Medicare Home Health benefit. This is not a change in the definition of homebound and is irrespective of the COVID-19 PHE,” CMS claims.
  • Clinicians eligible to certify/recertify. “In addition to a physician, section 3708 of the CARES Act allows a Medicare-eligible home health patient to be under the care of a nurse practitioner, clinical nurse specialist, or a physician assistant who is working in accordance with state law. These physicians/practitioners can: 1) order home health services; 2) establish and periodically review a plan of care for home health services (e.g., sign the plan of care); [and] 3) certify and re-certify that the patient is eligible for Medicare home health services,” CMS indicates. “This provision has been made permanent beyond the COVID-19 public health emergency and is codified in the regulations at 42 CFR 409.43.”
  • COVID vaccinations. “CMS will continue to pay about $40 per dose for administering COVID-19 vaccines in outpatient settings for Medicare beneficiaries through the end of the calendar year that the PHE ends,” i.e., 2023, the newly updated sheet says. “Effective January 1 of the year following the year that the PHE ends, CMS will set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines.” The sheet also notes that “we’ll continue to pay a total payment of approximately $75 per dose to administer COVID-19 vaccines in the home for certain Medicare patients through the end of the calendar year that the PHE ends,” but makes no mention of continuing the payment after 2023.
  • Occupational therapist assessments. In the 2022 home health final rule, CMS “finalized changes to § 484.55(a) and (b)(2) to permanently allow occupational therapists to complete the initial and comprehensive assessments for patients,” in accordance with the Consolidated Appropriations Act of 2021, according to the sheet.

In contrast, these waivers are scheduled to end with the PHE, CMS confirms:

  • Clinical records. HHAs must go back to providing a patient’s requested clinical record in four days, instead of 10 days.
  • Training and assessment of aides. RNs and therapists must again “make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency,” although CMS is “postponing completion of these visits,” it says. “All postponed onsite assessments must be completed ... no later than 60 days after the expiration of the PHE.”
  • In-services for aides. HHAs must once again “assure that each home health aide receives 12 hours of in-service training in a 12-month period,” although CMS is “postponing the deadline for completing this requirement … until the end of the first full quarter after the declaration of the PHE concludes,” i.e., September 2023.
  • Aide supervision visits. CMS is ending the waiver of the requirement for a nurse to conduct an onsite aide supervision visit every two weeks, it confirms. But the 2022 home health final rule did make a few allowances, including allowing “rare” virtual supervisory visits.
  • QAPI. CMS is ending the waiver allowing agencies to narrow the scope of their Quality Assurance and Performance Improvement program to infection control issues. It will end with the PHE.
  • OASIS reporting. When the PHE wraps up, HHAs must again complete the comprehensive assessment within five days and submit OASIS within 30 days.
  • Detailed information -sharing for discharge planning. HHAs will once again have to “provide detailed information regarding discharge planning, to patients and their caregivers, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to … quality measures and resource use measures” for those other providers, CMS says.
  • Various enrollment, appeals and Medicare Advantage waivers will end.

Note: See more details in the 13-page sheet at www.cms.gov/files/document/home-health-agencies-cms-flexibilities-fight-covid-19.pdf.

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