Home Health & Hospice Week

Making COVID-19 waivers permanent would be a start, expert says.

Medicare is saying all the right words when it comes to lightening providers’ regulatory load, but will it actually make a difference for home health and hospice agencies?

The Centers for Medicare & Medicaid Services is creating “the Office of Burden Reduction and Health Informatics to unify the agency’s efforts to reduce regulatory and administrative burden and to further the goal of putting patients first,” CMS says in a June 23 release. “The new office is an outgrowth of the agency’s Patients over Paperwork (PoP) Initiative, which is the cornerstone of CMS’s ongoing efforts to implement President Trump’s 2017 executive order to ‘Cut the Red Tape’ and eliminate duplicative, unnecessary, and excessively costly requirements and regulations. This announcement permanently embeds a culture of burden reduction across all platforms of CMS agency operations,” the agency pledges.

“The new office will strengthen CMS’s efforts across Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace to decrease the hours and costs clinicians and providers incur for CMS-mandated compliance,” CMS says. “It will take a proactive approach to reducing burden, carefully considering the impact of new regulations on health care system operations,” it adds.

“This reorganization should be viewed as a commitment to burden reduction,” praises National Association for Home Care & Hospice President William Dombi. “That is a good thing for home health and hospice.”

But some industry observers wonder if this initiative will move beyond mere lip service. So far, “we have not seen as much effort to simplify home health and hospice,” judges attorney Robert Markette Jr. with Hall Render in Indianapolis.

For example: In its release, CMS cites removal of “235 data elements from 33 items on the Outcomes and Assessment Information Set (OASIS) assessment instrument for home health” as one of its examples of “significant” burden reduction.

But at the same time CMS dropped those 33 items, it also imposed a number of new, more complex OASIS items in the GG and J sections. Experts said the additions made the changes a wash at best, and more burdensome at worst (see Eli’s HCW, Vol. XXVI, No. 42).

And CMS will be implementing 22 new standardized patient assessment data element (SPADE) items, plus some sub-items, in the new OASIS-E version which are expected to further burden HHAs (see Eli’s HCW, Vol. XXVIII, No. 41). OASIS-E was supposed to take effect Jan. 1, 2021, but it has been pushed back until at least 2022 due to the pandemic (Eli’s HCW, Vol. XXIX, No. 17).

HHAs have been pleading with CMS to make regulatory changes where they could really do some good — especially with face-to-face documentation requirements. But the agency hasn’t budged on that issue.

A Fresh Start

The formation of the new Office of Burden Reduction may be CMS’s chance to grant real regulatory relief to home care providers.

CMS could start with making many of the COVID-19 waivers permanent, Markette suggests. “These waivers have allowed home health and hospice a greater degree of flexibility and ... do not appear to have impacted patient care,” he tells Eli. “The waiver related to allowing initial assessments to occur remotely in home health, expanding the time frame to provide a copy of the patient’s clinical record from 4 days to 10 days and waiving the every-two-week, on-site supervisory visits all seem like examples of changes that could be made permanent,” Markette offers. (See details of those waivers in Eli’s HCW, Vol. XXIX, Nos. 11, 12-13, and 14.)

On the hospice side, “the use of telehealth/telecommuni­cations to supplement routine home care, the waiver of on-site supervisory visits every two weeks and the use of volunteers are also changes that seem ripe to be made permanent,” Markette suggests. “The extension of the time frame to complete the update of the comprehensive assessment from 15 to 21 days is another waiver change that CMS could consider making permanent.”

Another one: “The HHA and Hospice Aide annual training requirements may not need to be waived completely, but these last few months may have demonstrated that the overall training requirement could be reduced,” Markette adds.

Bottom line: “The fact that the home health and hospice industries have been operating without these requirements for several months is a strong indicator that they really are not that necessary,” Markette maintains. “Since we have already demonstrated that we can continue to care for our patients at a

high level without these waived requirements in place, it seems that eliminating them won’t harm anyone and will reduce the regulatory burden on providers.”

CMS may be signaling it is on board with the idea of extending COVID-19 waivers and even making them permanent. “CMS is committed to leveraging the significant flexibilities introduced in response to the COVID-19 pandemic as we continue to lead the rapid transformation to value-based healthcare,” the agency says in its release.

How receptive CMS is to the idea may depend on how many home care providers it hears from. “The new office will … increase the number of clinicians, providers, and health plans the Agency engages, to ensure that CMS has a better understanding of how various regulatory burdens impact healthcare delivery,” it says in the release. “Stakeholder feedback is critical to addressing provider and clinician burden, as it helps CMS to remove or modify outdated regulations that impede innovation, ultimately resulting in improvements in healthcare delivery.”

CMS later promises to “draw on the specialized expertise of staff, and frequent stakeholder input, to continue to explore innovative ways to address regulatory reform and burden reduction. All of these efforts will help ensure that providers and clinicians can focus their efforts on what is most important: keeping patients healthy, improving health outcomes, and enhancing patient satisfaction,” it says.

“The Office of Burden Reduction and Health Informatics will ensure the agency’s commitment to reduce administrative costs and enact meaningful and lasting change in our nation’s health care system,” CMS Administrator Seema Verma sums up. “Specifically, the work of this new office will be targeted to help reduce unnecessary burden, increase efficiencies, continue administrative simplification, increase the use of health informatics, and improve the beneficiary experience.”